Outcomes After Percutaneous Coronary Intervention or Bypass Surgery in Patients With Unprotected Left Main Disease

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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorCAVALCANTE, Rafael
dc.contributor.authorSOTOMI, Yohei
dc.contributor.authorLEE, Cheol W.
dc.contributor.authorAHN, Jung-Min
dc.contributor.authorFAROOQ, Vasim
dc.contributor.authorTATEISHI, Hiroki
dc.contributor.authorTENEKECIOGLU, Erhan
dc.contributor.authorZENG, Yaping
dc.contributor.authorSUWANNASOM, Pannipa
dc.contributor.authorCOLLET, Carlos
dc.contributor.authorALBUQUERQUE, Felipe N.
dc.contributor.authorONUMA, Yoshinobu
dc.contributor.authorPARK, Seung-Jung
dc.contributor.authorSERRUYS, Patrick W.
dc.date.accessioned2016-10-17T16:44:29Z
dc.date.available2016-10-17T16:44:29Z
dc.date.issued2016
dc.description.abstractBACKGROUND Currently available randomized data on the comparison between percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) for the treatment of unprotected left main coronary disease (LMD) lacks statistical power due to low numbers of patients enrolled. OBJECTIVES This study assessed long-term outcomes of PCI and CABG for the treatment of LMD in specific subgroups according to disease anatomic complexity. METHODS We conducted a pooled analysis of individual patient-level data of the LMD patients included in the PRECOMBAT (Bypass Surgery Versus Angioplasty Using Sirolimus-Eluting Stent in Patients With Left Main Coronary Artery Disease) and SYNTAX (Synergy Between PCI With TAXUS and Cardiac Surgery) trials. Incidences of major adverse cardiac events were assessed at 5 years follow-up. RESULTS Study population comprised 1,305 patients. The incidence of major adverse cardiac and cerebrovascular events at 5 years was 28.3% in the PCI group and 23.0% in the CABG group (hazard ratio [HR]: 1.23; 95% confidence interval [CI]: 1.01 to 1.55; p = 0.045). This difference is mainly driven by a higher rate of repeat revascularization associated with PCI (HR: 1.85; 95% CI: 1.38 to 2.47; p < 0.001). The 2 strategies showed similar rates of the safety composite endpoint of death, myocardial infarction, or stroke (p = 0.45). In patients with isolated LM or LM + 1-vessel disease, PCI was associated with a 60% reduction in all-cause mortality (HR: 0.40; 95% CI: 0.20 to 0.83; p = 0.029) and 67% reduction in cardiac mortality (HR: 0.33; 95% CI: 0.12 to 0.88; p = 0.025) when compared with CABG. CONCLUSIONS In patients with unprotected LMD, CABG, and PCI result in similar rates of the safety composite endpoint of death, myocardial infarction, or stroke. In patients with isolated LM or LM _ 1-vessel disease, PCI is associated with lower all-cause and cardiac mortality when compared to CABG. (C) 2016 by the American College of Cardiology Foundation.
dc.description.indexMEDLINE
dc.identifier.citationJOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, v.68, n.10, p.999-1009, 2016
dc.identifier.doi10.1016/j.jacc.2016.06.024
dc.identifier.eissn1558-3597
dc.identifier.issn0735-1097
dc.identifier.urihttps://observatorio.fm.usp.br/handle/OPI/16453
dc.language.isoeng
dc.publisherELSEVIER SCIENCE INC
dc.relation.ispartofJournal of the American College of Cardiology
dc.rightsrestrictedAccess
dc.rights.holderCopyright ELSEVIER SCIENCE INC
dc.subjectcoronary artery bypass graft surgery
dc.subjectleft main coronary artery disease
dc.subjectlong-term outcomes
dc.subjectpercutaneous coronary intervention
dc.subjectrandomized controlled trials
dc.subject.othersyntax score ii
dc.subject.othereluting stent implantation
dc.subject.otherartery-disease
dc.subject.other5-year outcomes
dc.subject.otherrandomized-trials
dc.subject.otherregistry
dc.subject.otherrevascularization
dc.subject.othermetaanalysis
dc.subject.othergraft
dc.subject.otherangioplasty
dc.subject.wosCardiac & Cardiovascular Systems
dc.titleOutcomes After Percutaneous Coronary Intervention or Bypass Surgery in Patients With Unprotected Left Main Disease
dc.typearticle
dc.type.categoryoriginal article
dc.type.versionpublishedVersion
dspace.entity.typePublication
hcfmusp.affiliation.countryInglaterra
hcfmusp.affiliation.countryCoréia do Sul
hcfmusp.affiliation.countryHolanda
hcfmusp.affiliation.countryisonl
hcfmusp.affiliation.countryisokr
hcfmusp.affiliation.countryisogb
hcfmusp.author.externalSOTOMI, Yohei:Univ Amsterdam, Acad Med Ctr, Amsterdam, Netherlands
hcfmusp.author.externalLEE, Cheol W.:Univ Ulsan, Coll Med, Asan Med Ctr, Inst Heart, Seoul, South Korea
hcfmusp.author.externalAHN, Jung-Min:Univ Ulsan, Coll Med, Asan Med Ctr, Inst Heart, Seoul, South Korea
hcfmusp.author.externalFAROOQ, Vasim:Cent Manchester Univ Hosp NHS Trust, Manchester Royal Infirm, Manchester Heart Ctr, Manchester, Lancs, England
hcfmusp.author.externalTATEISHI, Hiroki:Erasmus Univ, Med Ctr, Thoraxctr, Dept Intervent Cardiol, Rotterdam, Netherlands
hcfmusp.author.externalTENEKECIOGLU, Erhan:Erasmus Univ, Med Ctr, Thoraxctr, Dept Intervent Cardiol, Rotterdam, Netherlands
hcfmusp.author.externalZENG, Yaping:Erasmus Univ, Med Ctr, Thoraxctr, Dept Intervent Cardiol, Rotterdam, Netherlands
hcfmusp.author.externalSUWANNASOM, Pannipa:Univ Amsterdam, Acad Med Ctr, Amsterdam, Netherlands
hcfmusp.author.externalCOLLET, Carlos:Univ Amsterdam, Acad Med Ctr, Amsterdam, Netherlands
hcfmusp.author.externalALBUQUERQUE, Felipe N.:Erasmus Univ, Med Ctr, Thoraxctr, Dept Intervent Cardiol, Rotterdam, Netherlands
hcfmusp.author.externalONUMA, Yoshinobu:Erasmus Univ, Med Ctr, Thoraxctr, Dept Intervent Cardiol, Rotterdam, Netherlands
hcfmusp.author.externalPARK, Seung-Jung:Univ Ulsan, Coll Med, Asan Med Ctr, Inst Heart, Seoul, South Korea
hcfmusp.author.externalSERRUYS, Patrick W.:Imperial Coll London, Int Ctr Circulatory Hlth, London, England
hcfmusp.citation.scopus95
hcfmusp.contributor.author-fmusphcRAFAEL CAVALCANTE E SILVA
hcfmusp.description.beginpage999
hcfmusp.description.endpage1009
hcfmusp.description.issue10
hcfmusp.description.volume68
hcfmusp.origemWOS
hcfmusp.origem.scopus2-s2.0-84993949415
hcfmusp.origem.wosWOS:000382313500003
hcfmusp.publisher.cityNEW YORK
hcfmusp.publisher.countryUSA
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