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: A multicenter registry evaluating percutaneous coronary intervention versus coronary artery bypass grafting for left main treatment

Toru Naganuma, Alaide Chieffo, Emanuele Meliga, Davide Capodanno, Seung Jung Park, Yoshinobu Onuma, Marco Valgimigli, Sanda Jegere, Raj R. Makkar, Igor F. Palacios, Charis Costopoulos, Young Hak Kim, Piotr P. Buszman, Tarun Chakravarty, Imad Sheiban, Roxana Mehran, Christoph Naber, Ronan Margey, Arvind Agnihotri, Sebastiano MarraPiera Capranzano, Martin B. Leon, Jeffrey W. Moses, Jean Fajadet, Thierry Lefevre, Marie Claude Morice, Andrejs Erglis, Corrado Tamburino, Ottavio Alfieri, Patrick W. Serruys, Antonio Colombo

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish
Pages (from-to)354-361
Number of pages8
JournalJACC: Cardiovascular Interventions
Volume7
Issue number4
DOIs
Publication statusPublished - 2014

Keywords

  • coronary artery bypass grafting
  • ostial/midshaft lesion
  • percutaneous coronary intervention
  • unprotected left main coronary artery

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

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    Naganuma, T., Chieffo, A., Meliga, E., Capodanno, D., Park, S. J., Onuma, Y., Valgimigli, M., Jegere, S., Makkar, R. R., Palacios, I. F., Costopoulos, C., Kim, Y. H., Buszman, P. P., Chakravarty, T., Sheiban, I., Mehran, R., Naber, C., Margey, R., Agnihotri, A., ... Colombo, A. (2014). 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: A multicenter registry evaluating percutaneous coronary intervention versus coronary artery bypass grafting for left main treatment. JACC: Cardiovascular Interventions, 7(4), 354-361. https://doi.org/10.1016/j.jcin.2013.11.014