PCI vs. CABG in UPLM-ISR

Medical University of Silesia305 enrolled

Overview

Left main (LM) coronary artery disease is associated with high morbidity and mortality owing to the large myocardial territory at risk for ischemia. Evidence from randomized controlled trials supports that percutaneous coronary intervention (PCI) with drug-eluting stents (DES) for LM disease is an acceptable treatment strategy compared with coronary artery bypass graft surgery in patients with low or intermediate anatomic complexity. However in-stent restenosis (ISR) after DES in LM disease is still occurring with an incidence of 9,7%. Studies comparing the percutaneous coronary intervention with coronary artery bypass grafting (CABG) in the treatment of in-stent restenosis in unprotected left main have been scarce. While surgical revascularization is considered to be the standard treatment for this kind of stent failure, owing to a high risk of perioperative morbidity and mortality, the restoration of flow with PCI may be a reliable alternative. Additionally, it is not clear whether re-PCI is safe in these patients. Therefore, the purpose of the present study was to compare long-term outcomes following PCI or CABG for UPLM-ISR disease.

Study Type

OBSERVATIONAL

Enrollment

305

Conditions

Restenosis, Coronary Left Main Coronary Artery Disease PTCA Left Main Artery Complications

Interventions

Eligibility

Medical Language ↔ Plain English

Patients were divided into two separate cohorts for the analyses. The data included consecutive patients with ≥50% diameter UPLM-ISR, with or without multivessel coronary artery disease. Patients with an equivalent of UPLM-ISR: left main distal bifurcation disease, within the proximal 5 mm of the left anterior descending artery (LAD) or left circumflex artery (LCx) ostium (in the absence of significant angiographic stenosis in the left main coronary artery), were eligible. Patients who had protected LM-ISR, defined as the occurrence of at least one patent arterial or venous graft to the left coronary artery, other concomitant non-CABG procedure during surgery, were excluded.

Locations (11)

Fabrizio D'Ascenzo

Turin, Italy

Department of Invasive Cardiology, Medical University of Bialystok, The Medical University of Bialystok Clinical Hospital

Bialystok, Poland

First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland

Gdansk, Poland

Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland

Katowice, Poland

Jacek Legutko

Krakow, Poland

Second Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland

Krakow, Poland

Miedziowe Centrum Zdrowia S.A.

Lubin, Poland

Marek Grygier

Poznan, Poland

Department of Invasive Cardiology, Centre of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration

Warsaw, Poland

Centre for Heart Disease, University Hospital Wroclaw Department of Heart Disease, Wroclaw Medical University

Wroclaw, Poland

...and 1 more locations

Outcomes

Primary Outcomes

MACCE

Time frame: 4 years

Secondary Outcomes

cardiac death

Time frame: 4 years

myocardial infarction

Time frame: 4 years

target vessel revascularization

Time frame: 4 years

stroke

Time frame: 4 years