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

Piotr P. Buszman, Andrzej Bochenek, Magda Konkolewska, Blazej Trela, R. Stefan Kiesz, Mirosław Wilczyńnski, Marek Cisowski, Michał Krejca, Iwona Banasiewicz-Szkróobka, Marek Krol, Marek Kondys, Szymon Wiernek, Bartłomiej Orlik, Jack L. Martin, Michał Tendera, Pawel E. Buszman

Research output: Contribution to journalArticlepeer-review

15 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)564-569
Number of pages6
JournalJournal of Invasive Cardiology
Volume21
Issue number11
StatePublished - Nov 1 2009
Externally publishedYes

Keywords

  • Coronary artery bypass grafting (CABG)
  • Non-ST elevated acute coronary syndrome
  • Percutaneous coronary intervention (PCI)
  • Unprotected left main coronary artery disease

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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