Percutaneous treatment with drug-eluting stent implantation versus bypass surgery for unprotected left main stenosis: A single-center experience

Alaide Chieffo, Nuccia Morici, Francesco Maisano, Erminio Bonizzoni, John Cosgrave, Matteo Montorfano, Flavio Airoldi, Mauro Carlino, Iassen Michev, Gloria Melzi, Giuseppe Sangiorgi, Ottavio Alfieri, Antonio Colombo

Research output: Contribution to journalArticle

283 Citations (Scopus)

Abstract

BACKGROUND - Improvements in results with percutaneous coronary intervention (PCI) with drug-eluting stents (DES) may extend their use in patients with left main coronary artery (LMCA) stenosis. METHODS AND RESULTS - Two hundred forty-nine patients with LMCA stenosis were treated with PCI and DES implantation (n=107) or coronary artery bypass grafting (CABG) (n=142), in a single center, between March 2002 and July 2004. A propensity analysis was performed to adjust for baseline differences between the two cohorts. At 1 year, there was no statistical difference in the occurrence of death in PCI versus CABG both for the unadjusted (OR=0.291; 95% CI=0.054 to 1.085; P=0.0710) and adjusted analyses (OR=0.331; 95% CI=0.055 to 1.404; P=0.1673). PCI was correlated to a lower occurrence of the composite end points of death and myocardial infarction (unadjusted OR=0.235; 95% CI=0.048 to 0.580; P=0.0002; adjusted OR=0.260; 95% CI=0.078 to 0.597; P=0.0005) and death, myocardial infarction, and cerebrovascular events (unadjusted OR=0.300; 95% CI=0.102 to 0.617; P=0.0004; adjusted OR=0.385; 95% CI=0.180 to 0.819; P=0.01). No difference was detected in the occurrence of major adverse cardiac and cerebrovascular event at the unadjusted (OR=0.675; 95% CI=0.371 to 1.189; P=0.1891) and adjusted analyses (OR=0.568; 95% CI=0.229 to 1.344; P=0.2266). CONCLUSIONS - At 1 year, in this single-center, retrospective experience, there was no difference in the degree of protection against death, stroke, myocardial infarction, and revascularization between PCI with DES and CABG for LMCA disease.

Original languageEnglish
Pages (from-to)2542-2547
Number of pages6
JournalCirculation
Volume113
Issue number21
DOIs
Publication statusPublished - May 2006

Fingerprint

Drug-Eluting Stents
Percutaneous Coronary Intervention
Pathologic Constriction
Coronary Artery Bypass
Coronary Stenosis
Myocardial Infarction
Therapeutics
Myocardial Revascularization
Coronary Artery Disease
Stroke

Keywords

  • Drug-eluting stents
  • Left main coronary artery stenosis
  • Stents
  • Surgery

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Percutaneous treatment with drug-eluting stent implantation versus bypass surgery for unprotected left main stenosis : A single-center experience. / Chieffo, Alaide; Morici, Nuccia; Maisano, Francesco; Bonizzoni, Erminio; Cosgrave, John; Montorfano, Matteo; Airoldi, Flavio; Carlino, Mauro; Michev, Iassen; Melzi, Gloria; Sangiorgi, Giuseppe; Alfieri, Ottavio; Colombo, Antonio.

In: Circulation, Vol. 113, No. 21, 05.2006, p. 2542-2547.

Research output: Contribution to journalArticle

Chieffo, Alaide ; Morici, Nuccia ; Maisano, Francesco ; Bonizzoni, Erminio ; Cosgrave, John ; Montorfano, Matteo ; Airoldi, Flavio ; Carlino, Mauro ; Michev, Iassen ; Melzi, Gloria ; Sangiorgi, Giuseppe ; Alfieri, Ottavio ; Colombo, Antonio. / Percutaneous treatment with drug-eluting stent implantation versus bypass surgery for unprotected left main stenosis : A single-center experience. In: Circulation. 2006 ; Vol. 113, No. 21. pp. 2542-2547.
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abstract = "BACKGROUND - Improvements in results with percutaneous coronary intervention (PCI) with drug-eluting stents (DES) may extend their use in patients with left main coronary artery (LMCA) stenosis. METHODS AND RESULTS - Two hundred forty-nine patients with LMCA stenosis were treated with PCI and DES implantation (n=107) or coronary artery bypass grafting (CABG) (n=142), in a single center, between March 2002 and July 2004. A propensity analysis was performed to adjust for baseline differences between the two cohorts. At 1 year, there was no statistical difference in the occurrence of death in PCI versus CABG both for the unadjusted (OR=0.291; 95{\%} CI=0.054 to 1.085; P=0.0710) and adjusted analyses (OR=0.331; 95{\%} CI=0.055 to 1.404; P=0.1673). PCI was correlated to a lower occurrence of the composite end points of death and myocardial infarction (unadjusted OR=0.235; 95{\%} CI=0.048 to 0.580; P=0.0002; adjusted OR=0.260; 95{\%} CI=0.078 to 0.597; P=0.0005) and death, myocardial infarction, and cerebrovascular events (unadjusted OR=0.300; 95{\%} CI=0.102 to 0.617; P=0.0004; adjusted OR=0.385; 95{\%} CI=0.180 to 0.819; P=0.01). No difference was detected in the occurrence of major adverse cardiac and cerebrovascular event at the unadjusted (OR=0.675; 95{\%} CI=0.371 to 1.189; P=0.1891) and adjusted analyses (OR=0.568; 95{\%} CI=0.229 to 1.344; P=0.2266). CONCLUSIONS - At 1 year, in this single-center, retrospective experience, there was no difference in the degree of protection against death, stroke, myocardial infarction, and revascularization between PCI with DES and CABG for LMCA disease.",
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T2 - A single-center experience

AU - Chieffo, Alaide

AU - Morici, Nuccia

AU - Maisano, Francesco

AU - Bonizzoni, Erminio

AU - Cosgrave, John

AU - Montorfano, Matteo

AU - Airoldi, Flavio

AU - Carlino, Mauro

AU - Michev, Iassen

AU - Melzi, Gloria

AU - Sangiorgi, Giuseppe

AU - Alfieri, Ottavio

AU - Colombo, Antonio

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N2 - BACKGROUND - Improvements in results with percutaneous coronary intervention (PCI) with drug-eluting stents (DES) may extend their use in patients with left main coronary artery (LMCA) stenosis. METHODS AND RESULTS - Two hundred forty-nine patients with LMCA stenosis were treated with PCI and DES implantation (n=107) or coronary artery bypass grafting (CABG) (n=142), in a single center, between March 2002 and July 2004. A propensity analysis was performed to adjust for baseline differences between the two cohorts. At 1 year, there was no statistical difference in the occurrence of death in PCI versus CABG both for the unadjusted (OR=0.291; 95% CI=0.054 to 1.085; P=0.0710) and adjusted analyses (OR=0.331; 95% CI=0.055 to 1.404; P=0.1673). PCI was correlated to a lower occurrence of the composite end points of death and myocardial infarction (unadjusted OR=0.235; 95% CI=0.048 to 0.580; P=0.0002; adjusted OR=0.260; 95% CI=0.078 to 0.597; P=0.0005) and death, myocardial infarction, and cerebrovascular events (unadjusted OR=0.300; 95% CI=0.102 to 0.617; P=0.0004; adjusted OR=0.385; 95% CI=0.180 to 0.819; P=0.01). No difference was detected in the occurrence of major adverse cardiac and cerebrovascular event at the unadjusted (OR=0.675; 95% CI=0.371 to 1.189; P=0.1891) and adjusted analyses (OR=0.568; 95% CI=0.229 to 1.344; P=0.2266). CONCLUSIONS - At 1 year, in this single-center, retrospective experience, there was no difference in the degree of protection against death, stroke, myocardial infarction, and revascularization between PCI with DES and CABG for LMCA disease.

AB - BACKGROUND - Improvements in results with percutaneous coronary intervention (PCI) with drug-eluting stents (DES) may extend their use in patients with left main coronary artery (LMCA) stenosis. METHODS AND RESULTS - Two hundred forty-nine patients with LMCA stenosis were treated with PCI and DES implantation (n=107) or coronary artery bypass grafting (CABG) (n=142), in a single center, between March 2002 and July 2004. A propensity analysis was performed to adjust for baseline differences between the two cohorts. At 1 year, there was no statistical difference in the occurrence of death in PCI versus CABG both for the unadjusted (OR=0.291; 95% CI=0.054 to 1.085; P=0.0710) and adjusted analyses (OR=0.331; 95% CI=0.055 to 1.404; P=0.1673). PCI was correlated to a lower occurrence of the composite end points of death and myocardial infarction (unadjusted OR=0.235; 95% CI=0.048 to 0.580; P=0.0002; adjusted OR=0.260; 95% CI=0.078 to 0.597; P=0.0005) and death, myocardial infarction, and cerebrovascular events (unadjusted OR=0.300; 95% CI=0.102 to 0.617; P=0.0004; adjusted OR=0.385; 95% CI=0.180 to 0.819; P=0.01). No difference was detected in the occurrence of major adverse cardiac and cerebrovascular event at the unadjusted (OR=0.675; 95% CI=0.371 to 1.189; P=0.1891) and adjusted analyses (OR=0.568; 95% CI=0.229 to 1.344; P=0.2266). CONCLUSIONS - At 1 year, in this single-center, retrospective experience, there was no difference in the degree of protection against death, stroke, myocardial infarction, and revascularization between PCI with DES and CABG for LMCA disease.

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