scholarly journals Ten-Year All-Cause Death According to Completeness of Revascularization in Patients with Three-Vessel Disease or Left Main Coronary Artery Disease: Insights from the SYNTAX Extended Survival Study

Circulation ◽  
2021 ◽  
Author(s):  
Kuniaki Takahashi ◽  
Patrick W. Serruys ◽  
Chao Gao ◽  
Masafumi Ono ◽  
Rutao Wang ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Left Main Coronary Artery ◽  
Left Main ◽  
Unique Identifier ◽  
Vessel Disease ◽  
Main Coronary Artery Disease ◽  
Significant Difference ◽  
Artery Disease ◽  
Extended Survival

Background: Ten-year all-cause death according to incomplete (IR) versus complete revascularization (CR) has not been fully investigated in patients with three-vessel disease (3VD) and/or left main coronary artery disease (LMCAD) undergoing percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG). Methods: The SYNTAX Extended Survival Study evaluated vital status up to 10 years in patients who were originally enrolled in the SYNTAX trial. In the present sub-study, outcomes of the CABG CR group were compared with the CABG IR, PCI CR, and PCI IR groups. In addition, in the PCI cohort, the residual SYNTAX score (rSS) was used to quantify the extent of IR and to assess its association with fatal late outcome. The rSS of 0 suggests CR, whereas a rSS>0 identifies degree of IR. Results: IR was more frequently observed in patients with PCI vs. CABG (56.6% vs. 36.8%) and more common in those with 3VD than LMCAD in both PCI (58.5% vs. 53.8%) and CABG arm (42.8% vs. 27.5%). Patients undergoing PCI with CR had no significant difference in 10-year all-cause death compared with those undergoing CABG (22.2% for PCI with CR vs. 24.3% for CABG with IR vs. 23.8% for CABG with CR). In contrast, those with PCI and IR had a significantly higher risk of all-cause death at 10 years compared with CABG and CR (33.5% vs. 23.7%; adjusted hazard ratio [aHR]:1.48; 95% confidence interval [CI]:1.15-1.91). When patients with PCI were stratified according to the rSS, those with a rSS≤8 had no significant difference in all-cause death at 10 years as the other terciles (22.2% for rSS=0 vs. 23.9% for rSS>0-4 vs. 28.9% for rSS>4-8), whereas a rSS> 8 had a significantly higher risk of 10-year all-cause death as compared with those undergoing PCI with CR (50.1% vs. 22.2%; aHR:3.40; 95% CI:2.13-5.43). Conclusions: IR is common after PCI, and the degree of incompleteness was associated with 10-year mortality. If it is unlikely that complete (or nearly complete; rSS<8) revascularization can be achieved with PCI in patients with 3VD, CABG should be considered. Clinical Trial Registration: SYNTAX: https://www.clinicaltrials.gov Unique Identifier: NCT00114972. SYNTAX Extended Survival: https://www.clinicaltrials.gov Unique Identifier: NCT03417050

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 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 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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