scholarly journals TCT-33 Mortality After Repeat Revascularization Following PCI or CABG for Left Main Coronary Artery Disease: The EXCEL Trial

2018 ◽  
Vol 72 (13) ◽  
pp. B15
Author(s):  
Gennaro Giustino ◽  
Patrick Serruys ◽  
Roxana Mehran ◽  
Joseph Sabik ◽  
David Kandzari ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Left Main Coronary Artery ◽  
Left Main ◽  
Repeat Revascularization ◽  
Main Coronary Artery Disease ◽  
Artery Disease

scholarly journals Repeat revascularization impact on 10-year survival after PCI or CABG: post-hoc analysis of the SYNTAXES trial

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M Lunardi ◽  
M Ono ◽  
Y Onuma ◽  
P Serruys
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Left Main Coronary Artery ◽  
Bypass Graft ◽  
Left Main ◽  
Cox Regression Analysis ◽  
Repeat Revascularization ◽  
Main Coronary Artery Disease ◽  
Artery Disease ◽  
The Impact

Abstract Background Available data comparing Percutaneous Coronary Interventions (PCI) and Coronary Artery Bypass Graft (CABG) in multivessel or left main coronary artery disease (CAD) suggest higher rates of repeat revascularization events after PCI than CABG, with a negative influence on outcomes up to 5 years. The impact of repeat revascularization on very long-term outcomes remains unclear. Aims This study aims to investigate the impact on 10-year all-cause death of repeat revascularizations in patients with three-vessel disease (3VD) and/or left main coronary artery disease (LMCAD). Methods The SYNTAXES study evaluated the vital status out to 10-year of patients with 3VD and/or LMCAD enrolled in the SYNTAX trial. Repeat revascularization events occurred within the first 5 years from the index procedure were adjudicated by an independent clinical events committee. Effects of repeat revascularizations on 10-year all-cause death were investigated through time-dependent Cox regression analysis. Results During the first 5 years, 330 out of 1800 patients (18.3%) underwent a minimum of one repeat revascularization, for a total of 459 repeat revascularization procedures, mostly consisting of repeat-PCI (393, 85.6%). Repeat revascularizations were more frequent among patients initially randomized to PCI (HR 2.3, 95% CI: 1.8–3.0, p<0.0001). At 10 years, all-cause death was comparable between patients underwent any repeat revascularization and those not (27.6% vs. 25.1%, adjusted HR 2.3, 95% CI: 0.8–6.2, p=0.11). However, among patients requiring repeat revascularizations, who underwent initial PCI versus initial CABG presented a significantly higher 10-year all-cause death (32.7% vs 17.3%, p=0.004). The adjusted risk for 10-year all-cause death according to the subtypes of repeat revascularizations revealed only revascularization with CABG was an independent predictor (HR 6.2, 95% CI: 1.5–25.2, p=0.011). Conclusions In the SYNTAX trial, repeat revascularizations were more frequent after initial PCI. Although no difference on 10-year all-cause death was observed between patients who did undergo repeat revascularizations and who did not, higher death rates were reported among those required any repeat procedures after initial PCI or revascularization with CABG. These exploratory findings should be investigated with larger population in future studies. FUNDunding Acknowledgement Type of funding sources: None. Survival curves at 10-year follow-up

scholarly journals Ten-year all-cause death after percutaneous or surgical revascularization for men and women with multivessel or left main coronary artery disease: insights from the SYNTAX extended survival study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
H Hara ◽  
K Takahashi ◽  
D Klaveren ◽  
M Ono ◽  
H Kawashima ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Left Main Coronary Artery ◽  
Mortality Rates ◽  
Public Institution ◽  
Funding Source ◽  
Left Main ◽  
Main Coronary Artery Disease ◽  
Artery Disease ◽  
Extended Survival

Abstract Background In patients with complex coronary artery disease (CAD), women favored coronary artery bypass grafting surgery (CABG) compared to percutaneous coronary intervention (PCI) at 5 years in the SYNTAX trial, whereas mortality rates after PCI and CABG were not different in men. On the other hand, poor outcomes of women undergoing PCI were not observed in the PRECOMBAT and BEST trials. The long-term optimal revascularization strategy according to gender has not been fully evaluated. Purpose In the SYNTAX Extended Survival (SYNTAXES) study, no significant difference existed in all-cause death between PCI and CABG at 10 years. This study aimed to assess treatment effect of PCI and CABG for 10-year all-cause death according to gender. Methods The SYNTAXES study evaluated vital status up to 10 years in 1,800 patients with de novo three-vessel disease (3VD) and/or left main coronary artery disease (LMCAD) randomized to treatment with CABG or PCI in the SYNTAX trial, and the pre-specified primary endpoint was all-cause death at 10 years. In this prespecified analysis, all-cause death at 10 years according to gender in patients undergoing PCI or CABG was evaluated. Results Of 1800 patients, 402 (22.3%) were women and 1398 (77.7%) were men. In women, the rate of mortality was significantly higher in the PCI arm at 5 years than in the CABG arm (19.3% vs. 10.3%; Log-rank p=0.010, Figure A), but the rates of mortality were not different at 10 years between the PCI and CABG arms (33.0% vs. 32.5%; Log-rank p=0.600, Figure A). In men, the mortality rate tended to be higher in the PCI arm at 10 years than in the CABG arm (27.0% vs. 22.5%; Log-rank p=0.082, Figure B), although the mortality rates were not different at 5 years between the PCI and CABG arms (12.4% vs. 12.3%; Log-rank p=0.957, Figure B). Conclusion The efficacy of CABG observed at 5 years disappeared at 10 years in women, whereas the efficacy of CABG became apparent after 5 years in men. Figure 1 Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Erasmus University Medical Centre, Rotterdam, Netherlands, reference: MEC-2016-716

scholarly journals THREE-YEAR OUTCOMES AFTER REVASUCLARIZATON IN PATIENTS WITH UNPROTECTED LEFT MAIN CORONARY ARTERY DISEASE

2021 ◽  
Vol 77 (18) ◽  
pp. 1220
Author(s):  
Kazunori Mushiake ◽  
Masanobu Ohya ◽  
Chihiro Fujii ◽  
Takeshi Tada ◽  
Hiroyuki Tanaka ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Left Main Coronary Artery ◽  
Left Main ◽  
Main Coronary Artery Disease ◽  
Artery Disease

Comparison of Drug-Eluting Stents Versus Surgery for Unprotected Left Main Coronary Artery Disease

2007 ◽  
Vol 100 (6) ◽  
pp. 970-973 ◽  
Author(s):  
Marcelo Sanmartín ◽  
José Antonio Baz ◽  
Ramon Claro ◽  
Vanesa Asorey ◽  
Darío Durán ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Left Main Coronary Artery ◽  
Drug Eluting Stents ◽  
Left Main ◽  
Main Coronary Artery Disease ◽  
Drug Eluting ◽  
Artery Disease

scholarly journals A Case of Left Main Coronary Artery Disease in an Octogenarian Treated Surgically and Complicated by Myocardial Infarction: Decisions, Techniques, Rescue and Final Outcome

2013 ◽  
Vol 6 ◽  
pp. CCRep.S11542
Author(s):  
Antoine Kossaify ◽  
Gilles Grollier
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Left Main Coronary Artery ◽  
Bypass Graft ◽  
Left Main ◽  
Coronary Syndrome ◽  
Left Anterior Descending Artery ◽  
Main Coronary Artery Disease ◽  
Artery Disease

We report on an octogenarian patient presenting with an acute coronary syndrome due to significant left main coronary artery disease and severe ostial stenosis of the left anterior descending artery disease. Emergent bypass graft performed with “beating heart” consisted of left internal mammary graft to the mid left anterior descending artery with an “over-stent” anastomosis. The immediate post-operative phase was simple, however the patient presented on post-operative day 8 with extensive anterior myocardial infarction and cardiogenic shock. Emergent coronary angiogram showed subocclusive anastomotic stenosis. Percutaneous coronary intervention was performed on left main, proximal left anterior descending, and proximal circumflex arteries. Subsequently, the patient restored a satisfactory hemodynamic condition. A focus on the importance of decision for management of left main disease especially in octogenarian is presented, along with a review of the pertinent literature.

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