Document Detail

Early and long-term outcomes after surgical and percutaneous myocardial revascularization in patients with non-ST-elevation acute coronary syndromes and unprotected left main disease.
MedLine Citation:
PMID:  19901409     Owner:  NLM     Status:  MEDLINE    
Surgical myocardial revascularization (CABG) in patients with unprotected left main coronary artery disease (ULMCA) is a Class I recommendation in the AHA/ACC guidelines, however it is associated with increased perioperative risk in non-ST elevation acute coronary syndromes (NSTE-ACS). The aim of this study was to compare early and late results after percutaneous coronary intervention (PCI) and CABG in this cohort of patients. METHODS: A multicenter prospective registry included 138 patients with patent but severely narrowed (> 50%) ULMCA disease and NSTE-ACS diagnosed between January 2005 and April 2007. After emergent coronary angiography, 63 patients underwent PCI, whiles 75 were assigned for CABG. RESULTS: Groups were comparable with regard to sex, age and prevalence of diabetes mellitus (DM). They had similar left ventricular ejection fraction, SYNTAX Score and incidence of distal LM stenosis. However, PCI patients were at higher surgical risk (Euroscore 8.7 +/- 3.7 vs. 7.4 +/- 3.0; p = 0.02) and myocardial infarction incidence (28% vs. 14%; p = 0.07). The 30-day mortality was 1.5% after PCI vs. 12% after CABG (p = 0.043) and major adverse cardiovascular and cerebrovascular events (MACCE) were 3.2% vs. 14.7%, respectively (p = 0.04). After 12 months, there were 4 deaths in the PCI group and 12 deaths in the CABG group (6.3% vs. 16%; p = 0.14). There was no difference in MACCE (9.5% vs. 9.3% p = ns). Kaplan-Meier analysis revealed a trend toward better survival after PCI (p = 0.07). Revascularization with CABG and a Euroscore > 5 were the independent risk factors influencing early survival, while a Euroscore > 6 was the independent predictor of late mortality. CONCLUSIONS: PCI is a reasonable alternative to CABG in patients with NSTE-ACS and ULMCA stenosis.
Piotr P Buszman; Andrzej Bochenek; Magda Konkolewska; Blazej Trela; R Stefan Kiesz; Miros??aw Wilczy??ski; Marek Cisowski; Micha?? Krejca; Iwona Banasiewicz-Szkr??bka; Marek Krol; Marek Kondys; Szymon Wiernek; Bart??omiej Orlik; Jack L Martin; Micha?? Tendera; Pawel E Buszman
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of invasive cardiology     Volume:  21     ISSN:  1557-2501     ISO Abbreviation:  J Invasive Cardiol     Publication Date:  2009 Nov 
Date Detail:
Created Date:  2009-11-10     Completed Date:  2010-02-05     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8917477     Medline TA:  J Invasive Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  564-9     Citation Subset:  IM    
Medical University of Silesia, Katowice, Poland.
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MeSH Terms
Acute Coronary Syndrome* / mortality,  surgery,  therapy
Angioplasty, Transluminal, Percutaneous Coronary / mortality*
Coronary Artery Bypass / mortality*
Coronary Artery Disease* / mortality,  surgery,  therapy
Disease-Free Survival
Follow-Up Studies
Kaplan-Meiers Estimate
Middle Aged
Registries / statistics & numerical data
Risk Factors
Stents / statistics & numerical data*
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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