TY - JOUR
T1 - Long-term clinical outcomes after percutaneous coronary intervention versus coronary artery bypass grafting for ostial/midshaft lesions in unprotected left main coronary artery from the DELTA registry
T2 - A multicenter registry evaluating percutaneous coronary intervention versus coronary artery bypass grafting for left main treatment
AU - Naganuma, Toru
AU - Chieffo, Alaide
AU - Meliga, Emanuele
AU - Capodanno, Davide
AU - Park, Seung Jung
AU - Onuma, Yoshinobu
AU - Valgimigli, Marco
AU - Jegere, Sanda
AU - Makkar, Raj R.
AU - Palacios, Igor F.
AU - Costopoulos, Charis
AU - Kim, Young Hak
AU - Buszman, Piotr P.
AU - Chakravarty, Tarun
AU - Sheiban, Imad
AU - Mehran, Roxana
AU - Naber, Christoph
AU - Margey, Ronan
AU - Agnihotri, Arvind
AU - Marra, Sebastiano
AU - Capranzano, Piera
AU - Leon, Martin B.
AU - Moses, Jeffrey W.
AU - Fajadet, Jean
AU - Lefevre, Thierry
AU - Morice, Marie Claude
AU - Erglis, Andrejs
AU - Tamburino, Corrado
AU - Alfieri, Ottavio
AU - Serruys, Patrick W.
AU - Colombo, Antonio
PY - 2014
Y1 - 2014
N2 - Objectives: The aim of this study was to report the long-term clinical outcomes after percutaneous coronary intervention (PCI) with drug-eluting stents (DES) versus coronary artery bypass grafting (CABG) for ostial/midshaft lesions in an unprotected left main coronary artery (ULMCA). Background: Data regarding outcomes in these patients are limited. Methods: Of a total of 2,775 patients enrolled in the DELTA multinational registry, 856 patients with isolated ostial/midshaft lesions in an ULMCA treated by PCI with DES (n = 482) or CABG (n = 374) were analyzed. Results: At a median follow-up period of 1,293 days, there were no significant differences in the propensity score-adjusted analyses for the composite endpoint of all-cause death, myocardial infarction (MI), and cerebrovascular accident (hazard ratio [HR]: 1.21, 95% confidence interval [CI]: 0.79 to 1.86; p = 0.372), all-cause death (HR: 1.35, 95% CI: 0.80 to 2.27; p = 0.255), the composite endpoint of all-cause death and MI (HR: 1.33, 95% CI: 0.83 to 2.12; p = 0.235) and major adverse cardiac and cerebrovascular events (HR: 1.34, 95% CI: 0.93 to 1.93; p = 0.113). These results were sustained after propensity-score matching. However, a higher incidence of target vessel revascularization (HR: 1.94, 95% CI: 1.03 to 3.64; p = 0.039) was observed in the PCI compared with the CABG group, with a trend toward higher target lesion revascularization (HR: 2.00, 95% CI: 0.90 to 4.45; p = 0.090). Conclusions: This study demonstrates that PCI for ostial/midshaft lesions in an ULMCA is associated with clinical outcomes comparable to those observed with CABG at long-term follow-up, despite the use of older first-generation DES.
AB - Objectives: The aim of this study was to report the long-term clinical outcomes after percutaneous coronary intervention (PCI) with drug-eluting stents (DES) versus coronary artery bypass grafting (CABG) for ostial/midshaft lesions in an unprotected left main coronary artery (ULMCA). Background: Data regarding outcomes in these patients are limited. Methods: Of a total of 2,775 patients enrolled in the DELTA multinational registry, 856 patients with isolated ostial/midshaft lesions in an ULMCA treated by PCI with DES (n = 482) or CABG (n = 374) were analyzed. Results: At a median follow-up period of 1,293 days, there were no significant differences in the propensity score-adjusted analyses for the composite endpoint of all-cause death, myocardial infarction (MI), and cerebrovascular accident (hazard ratio [HR]: 1.21, 95% confidence interval [CI]: 0.79 to 1.86; p = 0.372), all-cause death (HR: 1.35, 95% CI: 0.80 to 2.27; p = 0.255), the composite endpoint of all-cause death and MI (HR: 1.33, 95% CI: 0.83 to 2.12; p = 0.235) and major adverse cardiac and cerebrovascular events (HR: 1.34, 95% CI: 0.93 to 1.93; p = 0.113). These results were sustained after propensity-score matching. However, a higher incidence of target vessel revascularization (HR: 1.94, 95% CI: 1.03 to 3.64; p = 0.039) was observed in the PCI compared with the CABG group, with a trend toward higher target lesion revascularization (HR: 2.00, 95% CI: 0.90 to 4.45; p = 0.090). Conclusions: This study demonstrates that PCI for ostial/midshaft lesions in an ULMCA is associated with clinical outcomes comparable to those observed with CABG at long-term follow-up, despite the use of older first-generation DES.
KW - coronary artery bypass grafting
KW - ostial/midshaft lesion
KW - percutaneous coronary intervention
KW - unprotected left main coronary artery
UR - http://www.scopus.com/inward/record.url?scp=84898802471&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84898802471&partnerID=8YFLogxK
U2 - 10.1016/j.jcin.2013.11.014
DO - 10.1016/j.jcin.2013.11.014
M3 - Article
C2 - 24630886
AN - SCOPUS:84898802471
VL - 7
SP - 354
EP - 361
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
SN - 1936-8798
IS - 4
ER -