Comparison of long-term outcomes of minimally invasive coronary artery bypass grafting and percutaneous coronary intervention for left main disease.

IF 1.5 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Coronary artery disease Pub Date : 2025-01-17 DOI:10.1097/MCA.0000000000001504

Ahmet Güner, Cemil Can, Fatih Furkan Bedir, Ünal Aydin, Ersin Kadiroğullari, Cemalettin Akman, Ezgi Gültekin Güner, Emre Aydin, Berkay Serter, Ahmet Yaşar Çizgici, İbrahim Faruk Aktürk, Taner İyigün, Timuçin Aksu, Abdullah Doğan, Merve Aydin, Aybüke Şimşek, Fatih Uzun

{"title":"Comparison of long-term outcomes of minimally invasive coronary artery bypass grafting and percutaneous coronary intervention for left main disease.","authors":"Ahmet Güner, Cemil Can, Fatih Furkan Bedir, Ünal Aydin, Ersin Kadiroğullari, Cemalettin Akman, Ezgi Gültekin Güner, Emre Aydin, Berkay Serter, Ahmet Yaşar Çizgici, İbrahim Faruk Aktürk, Taner İyigün, Timuçin Aksu, Abdullah Doğan, Merve Aydin, Aybüke Şimşek, Fatih Uzun","doi":"10.1097/MCA.0000000000001504","DOIUrl":null,"url":null,"abstract":"Background: Minimally invasive coronary artery bypass grafting (MICS-CABG) is frequently used for coronary revascularization, but the comparison of long-term clinical results with percutaneous coronary intervention (PCI) in left main disease (LMDs) remains unclear. The present study sought to determine the long-term outcomes of MICS-CABG and PCI in patients with LMDs.Methods: A total of 551 consecutive patients [man: 457 (82.9%), mean age: 60.70 ± 9.54 years] who underwent PCI or MICS-CABG for LMDs were included. The primary endpoint was defined as the all-cause death during follow-up. The secondary endpoint defined as the major cardiovascular and cerebral events (MACCE) included cardiac death, myocardial infarction, target vessel revascularization, stroke, and stent thrombosis or graft occlusion. Inverse probability weighting (IPW) was performed to reduce treatment selection bias. This is the first report comparing the long-term outcomes of MICS-CABG and PCI in patients with LMDs.Results: The initial revascularization strategy was MICS-CABG in 269 (48.8%) cases and PCI in 282 (51.2%) patients. The SYNTAX scores (31.25 ± 4.63 vs. 26.05 ± 5.9, P < 0.001) were notably higher in the MICS-CABG group than in the PCI group. The incidence of long-term mortality (11 vs. 5.6%, P = 0.022) and MACCE (22 vs. 15.2%, P = 0.042) were notably higher in the PCI group than in the MICS-CABG group. The long-term mortality [adjusted HR (IPW) = 6.38 (95% CI, 3.00-13.57), P < 0.001] and MACCE [adjusted HR (IPW) = 4.51 (95% CI, 2.90-7.03), P < 0.001] in the overall population significantly differed between the PCI group and the MICS-CABG group.Conclusion: The present study suggests that MICS-CABG for LMDs was associated with lower long-term mortality and MACCE rates than PCI.","PeriodicalId":10702,"journal":{"name":"Coronary artery disease","volume":" ","pages":""},"PeriodicalIF":1.5000,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Coronary artery disease","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/MCA.0000000000001504","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Minimally invasive coronary artery bypass grafting (MICS-CABG) is frequently used for coronary revascularization, but the comparison of long-term clinical results with percutaneous coronary intervention (PCI) in left main disease (LMDs) remains unclear. The present study sought to determine the long-term outcomes of MICS-CABG and PCI in patients with LMDs.

Methods: A total of 551 consecutive patients [man: 457 (82.9%), mean age: 60.70 ± 9.54 years] who underwent PCI or MICS-CABG for LMDs were included. The primary endpoint was defined as the all-cause death during follow-up. The secondary endpoint defined as the major cardiovascular and cerebral events (MACCE) included cardiac death, myocardial infarction, target vessel revascularization, stroke, and stent thrombosis or graft occlusion. Inverse probability weighting (IPW) was performed to reduce treatment selection bias. This is the first report comparing the long-term outcomes of MICS-CABG and PCI in patients with LMDs.

Results: The initial revascularization strategy was MICS-CABG in 269 (48.8%) cases and PCI in 282 (51.2%) patients. The SYNTAX scores (31.25 ± 4.63 vs. 26.05 ± 5.9, P < 0.001) were notably higher in the MICS-CABG group than in the PCI group. The incidence of long-term mortality (11 vs. 5.6%, P = 0.022) and MACCE (22 vs. 15.2%, P = 0.042) were notably higher in the PCI group than in the MICS-CABG group. The long-term mortality [adjusted HR (IPW) = 6.38 (95% CI, 3.00-13.57), P < 0.001] and MACCE [adjusted HR (IPW) = 4.51 (95% CI, 2.90-7.03), P < 0.001] in the overall population significantly differed between the PCI group and the MICS-CABG group.

Conclusion: The present study suggests that MICS-CABG for LMDs was associated with lower long-term mortality and MACCE rates than PCI.

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

微创冠状动脉旁路移植术与经皮冠状动脉介入治疗左主干病变的远期疗效比较。

背景：微创冠状动脉旁路移植术（MICS-CABG）常用于冠状动脉血运重建术，但与经皮冠状动脉介入治疗（PCI）在左主干疾病（LMDs）中的长期临床效果比较尚不清楚。本研究旨在确定MICS-CABG和PCI对lmd患者的长期预后。方法：共纳入551例连续行PCI或MICS-CABG治疗LMDs的患者[男性：457例（82.9%），平均年龄：60.70±9.54岁]。主要终点定义为随访期间的全因死亡。次要终点定义为主要心脑血管事件（MACCE），包括心源性死亡、心肌梗死、靶血管重建术、卒中、支架血栓形成或移植物闭塞。采用逆概率加权（IPW）来减少治疗选择偏差。这是第一份比较MICS-CABG和PCI治疗lmd患者长期预后的报告。结果：最初的血运重建策略为269例（48.8%）采用MICS-CABG， 282例（51.2%）采用PCI。SYNTAX评分（31.25±4.63 vs. 26.05±5.9，P）结论：本研究表明，MICS-CABG治疗LMDs的长期死亡率和MACCE率低于PCI。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文去求助

来源期刊

Coronary artery disease 医学-外周血管病

CiteScore

2.50

自引率

0.00%

发文量

190

审稿时长

6-12 weeks

期刊介绍： Coronary Artery Disease welcomes reports of original research with a clinical emphasis, including observational studies, clinical trials, translational research, novel imaging, pharmacology and interventional approaches as well as advances in laboratory research that contribute to the understanding of coronary artery disease. Each issue of Coronary Artery Disease is divided into four areas of focus: Original Research articles, Review in Depth articles by leading experts in the field, Editorials and Images in Coronary Artery Disease. The Editorials will comment on selected original research published in each issue of Coronary Artery Disease, as well as highlight controversies in coronary artery disease understanding and management. Submitted artcles undergo a preliminary review by the editor. Some articles may be returned to authors without further consideration. Those being considered for publication will undergo further assessment and peer-review by the editors and those invited to do so from a reviewer pool.