scholarly journals Long-term prediction of mortality and comparative treatment benefit following percutaneous or surgical revascularization

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
H Hara ◽  
H Shiomi ◽  
D Van Klaveren ◽  
D Kent ◽  
E W Steyerberg ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Absolute Risk ◽  
Artery Bypass ◽  
Risk Difference ◽  
Syntax Score ◽  
Left Main ◽  
Left Main Disease ◽  
Treatment Benefit ◽  
Vessel Disease ◽  
Prediction Of Mortality

Abstract Background The SYNTAX score II 2020 (SSII-2020), which was derived and externally validated from randomized trials, was designed to predict death following percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in patients with three-vessel disease and/or left main disease. We aimed to investigate its value in identifying the safest modality of revascularization in a non-randomized setting. Methods Five-year mortality was assessed in 7362 patients with three-vessel disease and/or left main disease enrolled in a Japanese PCI/CABG registry. New-generation drug eluting stents and imaging guidance became the default PCI strategy during enrolment of the last cohort. The discriminative ability of the SSII-2020 for 5-year mortality was assessed using Harrell's C statistic (C-index). Agreement between observed and predicted rates of all-cause mortality following either PCI or CABG and treatment benefit (absolute risk difference) for this outcome were assessed by calibration plots. Results The SSII-2020 had helpful discrimination (C-index = 0.72) and good calibration (intercept = −0.11, slope = 0.92) for 5-year mortality. The absolute risk difference in mortality between CABG and PCI (treatment benefit) was well calibrated when the whole population was grouped into quarters according to the predicted absolute risk difference of 5-year mortality. The observed differences in survival in favor of CABG were 4.2% (0.1 to 8.2%, log-rank p=0.05) and 8.5% (3.8 to 13.2%, log-rank p<0.01) in the respective third and fourth quarters. In contrast, the observed differences in survival were not significantly different in either the first (3.0% [−0.8 to 6.8%, log-rank p=0.12]) or the second quarter (1.3% [−2.4 to 5.1%, log-rank p=0.39]). Conclusions The SSII-2020 is well able to predict death at 5 years – and the mortality difference between PCI and CABG, and therefore has the potential to support decision making on revascularization in patients with three-vessel disease and/or left main coronary artery disease. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Is Complete Revascularisation Mandated for all Patients with Multivessel Coronary Artery Disease?

2017 ◽  
Vol 13 (01) ◽  
pp. 45 ◽  
Author(s):  
Carlo De Innocentiis ◽  
Marco Zimarino ◽  
Raffaele De Caterina ◽  
◽  
◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Artery Bypass ◽  
Multivessel Coronary Artery Disease ◽  
Left Main ◽  
Left Main Disease ◽  
Vessel Disease ◽  
Myocardial Revascularisation ◽  
Artery Disease ◽  
Complete Revascularisation

In multivessel coronary artery disease (MVCAD), myocardial revascularisation can be achieved by percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG), with complete revascularisation on all diseased coronary segments or with incomplete revascularisation on selectively targeted lesions. Complete revascularisation confers a long-term prognostic benefit, but is associated with a higher rate of periprocedural events compared with incomplete revascularisation. In most patients with MVCAD, the main advantage of CABG over PCI is conferred by the achievement of more extensive revascularisation. According to current international guidelines, PCI is generally preferred in single-vessel disease, low-risk MVCAD or isolated left main disease; whereas CABG is usually recommended in patients with complex two-vessel disease, most patients with three-vessel disease and/or non-isolated left main disease. In patients with MVCAD, the choice on revascularisation modality should depend on a multifactorial evaluation, taking into account not only coronary anatomy, the ischaemic burden, myocardial function, age and the presence of comorbidities, but also the adequacy of myocardial revascularisation.

scholarly journals Therapeutic Options for Left Main, Left Main Equivalent, and Three-Vessel Disease

2021 ◽  
Author(s):  
James J. Glazier ◽  
Bayoan Ramos-Parra ◽  
Amir Kaki
Keyword(s):  
Diabetes Mellitus ◽  
Coronary Artery ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Syntax Score ◽  
Left Main ◽  
Cabg Surgery ◽  
Vessel Disease ◽  
Percutaneous Coronary ◽  
Patients With Diabetes

AbstractPatients with left main, left main equivalent, and three-vessel coronary artery disease (CAD) represent an overlapping spectrum of patients with advanced CAD that is associated with an adverse prognosis. Guideline-directed medical therapy is a necessary but often insufficient treatment option, as such patients frequently need mechanical revascularization by either coronary artery bypass graft (CABG) surgery or percutaneous coronary intervention (PCI). In patients with advanced CAD presenting with acute myocardial infarction, PCI, of course, is the preferred treatment option. For stable patients with advanced CAD, CABG surgery remains the standard of care. However, observations from the SYNergy between Percutaneous Coronary Intervention with TAXus and Cardiac Surgery (SYNTAX) trial suggest that PCI may be a useful alternative in patients with three-vessel disease with a low SYNTAX score as well as in patients with left main disease and a low or intermediate SYNTAX score. In the subset of patients with diabetes mellitus, the Future Revascularization Evaluation in Patients with Diabetes Mellitus: Optimal Management of Multivessel Disease trial unequivocally demonstrated the superiority of CABG surgery in improving outcomes. The findings of the recently published Everolimus-Eluting Stent System versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization and Nordic–Baltic–British Left Main Revascularization study trials point to a favorable role for PCI in certain low-to-moderate risk patients with left main stem disease.

CABG versus PCI in the Treatment of Unprotected Left Main Disease in Diabetics: A Literature Review

2021 ◽  
Vol 30 (03) ◽  
pp. 187-193
Author(s):  
Daniel Lambert ◽  
Allan Mattia ◽  
Angel Hsu ◽  
Frank Manetta
Keyword(s):  
Coronary Artery ◽  
Artery Bypass ◽  
Treatment Strategies ◽  
Coronary Intervention ◽  
Diabetic Patients ◽  
Left Main ◽  
Left Main Disease ◽  
Unprotected Left Main Disease ◽  
Long Term Follow Up ◽  
Artery Disease

AbstractThe approach to left main coronary artery disease (CAD) in diabetic patients has been extensively debated. Diabetic patients have an elevated risk of left main disease in addition to multivessel disease. Previous trials have shown increased revascularization rates in percutaneous coronary intervention compared with coronary artery bypass grafting (CABG) but overall comparable outcomes, although many of these studies were not using the latest stent technology or CABG with arterial revascularization. Our aim is to review the most recent trials that have recently published long-term follow-up, as well as other literature pertaining to left main disease in diabetic patients. Furthermore, we will be discussing some future treatment strategies that could likely create a paradigm shift in how left main CAD is managed.

scholarly journals Mid-term and long-term results of off-pump coronary artery bypass grafting for patients with left main disease

2015 ◽  
Vol 21 (3) ◽  
pp. 179-184
Author(s):  
Tomohiro Mizuno ◽  
Keishi Oi ◽  
Masafumi Yashima ◽  
Tsuyoshi Hachimaru ◽  
Daiju Watanabe ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Artery Bypass ◽  
Long Term Results ◽  
Bypass Grafting ◽  
Left Main ◽  
Left Main Disease ◽  
Off Pump ◽  
Pump Coronary Artery Bypass

A Survey of Transesophageal Echocardiography

2018 ◽  
pp. 65-68
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Syntax Score ◽  
Severe Coronary Artery Disease ◽  
Left Main ◽  
Attractive Option ◽  
Severe Coronary Artery ◽  
Artery Disease

This case focuses on the use of cardiac stents vs. coronary artery bypass surgery for severe coronary artery disease by asking the question: Should patients with severe coronary artery disease (three-vessel and/or left main disease) be treated with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG)? For patients with three-vessel and/or left main coronary artery disease, CABG reduced rates of major cardiovascular and cerebrovascular events compared with PCI. This difference was largely driven by a reduction in the need for repeat revascularization procedures among patients receiving CABG. Patients who received PCI had a lower rate of stroke, however, which may make PCI an attractive option for some patients. In addition, the authors suggest that patients with less complex coronary artery disease (as assessed using the SYNTAX score) may be particularly good candidates for PCI, but this hypothesis requires further validation.

Surgery for Chronic Total Occlusion of the Left Main Stem: A 10-Year Experience

2009 ◽  
Vol 17 (5) ◽  
pp. 472-476 ◽  
Author(s):  
Raja Parvez Akhtar ◽  
Mumraiz Salik Naqshband ◽  
Abdul Rehman Abid ◽  
Zafar Tufail ◽  
Abdul Waheed ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Chronic Total Occlusion ◽  
Artery Bypass ◽  
Main Stem ◽  
Hospital Death ◽  
Left Main ◽  
Total Occlusion ◽  
Vessel Disease ◽  
Left Main Stem ◽  
Ischemic Attack

Chronic total occlusion of the left main stem coronary artery is rare. This retrospective study was conducted to evaluate outcomes of coronary artery bypass grafting between June 1998 and June 2008 in patients with chronic left main stem total occlusion. There were 17 (0.025%) cases detected in 67,082 coronary angiograms. The 14 men and 3 women had a mean age of 55.32 ± 9.2 years. Risk factors included diabetes in 8, hypertension in 6, and smoking in 6. Of 54 grafts applied, 15 were arterial and 39 were venous; 14 patients had 3-vessel disease, and 3 had 4-vessel disease. Three patients required intraaortic balloon counterpulsation perioperatively. The mean intensive care unit stay was 2.1 ± 1.2 days, and hospital stay was 7.1 ± 1.5 days. Postoperatively, one patient suffered myocardial infarction, another had a transient ischemic attack with spontaneous recovery, and 2 developed atrial fibrillation. There was no operative or hospital death. Surgical revascularization is considered appropriate treatment for chronic total occlusion of the left main stem.

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