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Early and long-term outcomes of coronary artery bypass grafting and percutaneous coronary intervention in patients with left main disease: single-center results of multidisciplinary decision making.
MedLine Citation:
PMID:  24317798     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVE: Coronary artery bypass grafting (CABG) is considered the standard treatment for patients with left main disease (LMD). However, percutaneous coronary intervention (PCI) has recently emerged as a treatment option for selected patients. We assessed early and long-term outcomes of patients with LMD who underwent either CABG or PCI in our institution.
METHODS: We reviewed the records of 438 patients with LMD who underwent revascularization between January 2005 and December 2010. Treatment modality, chosen by our heart team, was CABG in 409 patients and PCI in 29. Age, prevalence of women, and mean ejection fraction of patients were not significantly different between groups. Mean logistic European system for cardiac operative risk evaluation score was 7.7. Mean follow-up was 37.1 months.
RESULTS: In CABG group, mean number of anastomoses was 4.0 and complete revascularization was achieved in 97.1 %. Bilateral internal thoracic arteries were used in 87.0 %. In PCI group, mean number of stents was 1.3 and complete revascularization was achieved in 44.8 %. Drug-eluting stent was used in 72.4 %. In-hospital mortality was 1.1 % (1.0 %, CABG group vs. 3.4 %, PCI group; p = 0.29). At 3 years, overall survival was 94.3 % (95.3 vs. 81.1 %; p < 0.01) and rate of freedom from major adverse cardiac events and cerebrovascular accidents was 88.9 % (89.8 vs. 77.3 %; p = 0.05).
CONCLUSIONS: Our heart team's approach resulted in favorable overall results in patients with LMD. Multidisciplinary decision making in these high-risk patients can make good long-term outcomes in CABG.
Authors:
Toshihiro Fukui; Minoru Tabata; Tetsuya Tobaru; Ryuta Asano; Shuichiro Takanashi; Tetsuya Sumiyoshi
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-12-8
Journal Detail:
Title:  General thoracic and cardiovascular surgery     Volume:  -     ISSN:  1863-6713     ISO Abbreviation:  Gen Thorac Cardiovasc Surg     Publication Date:  2013 Dec 
Date Detail:
Created Date:  2013-12-9     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101303952     Medline TA:  Gen Thorac Cardiovasc Surg     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Department of Cardiovascular Surgery, Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu, Tokyo, 183-0003, Japan, tfukui.cvs@gmail.com.
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