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 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.

The impact of cardiovascular risk factors on subclinical left main coronary artery disease: An intravascular ultrasound study

2006 ◽  
Vol 152 (4) ◽  
pp. 693.e7-693.e12 ◽  
Author(s):  
Sang-Wook Kim ◽  
Gary S. Mintz ◽  
Esteban Escolar ◽  
Patrick Ohlmann ◽  
Jerzy Pregowski ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Cardiovascular Risk ◽  
Coronary Artery ◽  
Left Main Coronary Artery ◽  
Left Main ◽  
Main Coronary Artery Disease ◽  
Ultrasound Study ◽  
Artery Disease ◽  
The Impact

scholarly journals Percutaneous Intervention or Bypass Graft for Left Main Coronary Artery Disease? A Systematic Review and Meta-Analysis

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Waqas Ullah ◽  
Yasar Sattar ◽  
Irfan Ullah ◽  
Ammu Susheela ◽  
Maryam Mukhtar ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Left Main Coronary Artery ◽  
Bypass Graft ◽  
Random Effect Model ◽  
Left Main ◽  
Main Coronary Artery Disease ◽  
Significant Difference ◽  
All Cause Mortality ◽  
Artery Disease

Background. The safety and efficacy of percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) for stable left main coronary artery disease (LMCAD) remains controversial. Methods. Digital databases were searched to compare the major adverse cardiovascular and cerebrovascular events (MACCE) and its components. A random effect model was used to compute an unadjusted odds ratio (OR). Results. A total of 43 studies (37 observational and 6 RCTs) consisting of 29,187 patients (PCI 13,709 and CABG 15,478) were identified. The 30-day rate of MACCE (OR, 0.56; 95% CI, 0.42–0.76; p = 0.0002) and all-cause mortality (OR, 0.52; 95% CI, 0.30–0.91; p = 0.02) was significantly lower in the PCI group. There was no significant difference in the rate of myocardial infarction (MI) (p = 0.17) and revascularization (p = 0.12). At 5 years, CABG was favored due to a significantly lower rate of MACCE (OR, 1.67; 95% CI, 1.18–2.36; p = <0.04), MI (OR, 1.67; 95% CI, 1.35–2.06; p = <0.00001), and revascularization (OR, 2.80; 95% CI, 2.18–3.60; p = <0.00001), respectively. PCI was associated with a lower overall rate of a stroke, while the risk of all-cause mortality was not significantly different between the two groups at 1- (p = 0.75), 5- (p = 0.72), and 10-years (p = 0.20). The Kaplan–Meier curve reconstruction revealed substantial variations over time; the 5-year incidence of MACCE was 38% with CABG, significantly lower than 45% with PCI (p = <0.00001). Conclusion. PCI might offer early safety advantages, while CABG provides greater durability in terms of lower long-term risk of ischemic events. There appears to be an equivalent risk for all-cause mortality.

scholarly journals Coronary Artery Bypass Graft for Left Main Coronary Artery Disease

2015 ◽  
Vol 22 (2) ◽  
pp. 25-29
Author(s):  
Husain H. Jabbad
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Left Main Coronary Artery ◽  
Bypass Graft ◽  
Main Group ◽  
Morbidity And Mortality ◽  
Left Main ◽  
Main Coronary Artery Disease ◽  
Artery Disease

Because left main coronary artery disease carries a high risk of morbidity and mortality, this retrospective study will review the data and results of surgical management of left main coronary artery disease, in King Abdulaziz University Hospital. 448 patients underwent coronary bypass graft into two groups, left main group (50) patients and non-left main group (398) patients. Preoperative data, risk factors and cardiac catheterization findings were compared in between the two groups in addition to perioperative morbidity and mortality. Patients in the left main group were younger in age with significantly lower ejection fraction and more risk factors (hypertension, dyslipidemia, and smoking). In our study the left main group patients had higher mortality than non-left main patients [4 patients = 8%, 6 patients = 1.8%]; the most common cause of perioperative mortality in the left main group was low cardiac output state, and the most common complications were perioperative myocardial infarction and prolonged ventilation. The higher mortality and morbidity associated with surgery for left main coronary artery disease can be explained by the higher risk profi le, the need of urgent surgery and critical preoperative status.  

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