[Percutaneous coronary intervention of unprotected left main coronary compared with coronary artery bypass grafting; 3 years of experience in the National Institute of Cardiology, Mexico]

Arch Cardiol Mex. 2018 Apr-Jun;88(2):83-92. doi: 10.1016/j.acmx.2016.07.003. Epub 2016 Aug 21.
[Article in Spanish]

Abstract

Background: The best revascularisation method of the unprotected left main artery is a current and evolving topic.

Methods: A total of 2439 percutaneous coronary interventions (PCI) were registered during a 3-year period. The study included all the patients with PCI of the unprotected left main coronary (n=48) and matched with patients who underwent coronary artery bypass graft (CABG) (n=50). Major adverse cerebral and cardiac events (MACCE) were assessed within the hospital and in outpatients during a 16 month follow up.

Results: The cardiovascular risk was greater in the PCI group; logEuroSCORE 16±21 vs. 5±6, P=.001; clinical Syntax 77±74 vs 53±39, P=.04. On admission, the PCI group of patients had a higher frequency of ST segment elevation myocardial infarction (STEMI) and cardiogenic shock. The MACCE were similar in both groups (14% vs. 18%, P=.64). STEMI was less frequent in the PCI group (0% vs. 10%, P=.03). Cardiovascular events were lower in the PCI group (2.3% vs. 18%, P=.01), and there was a decrease in general and cardiac mortality (2.3% vs. 12%, P=.08 y 2.3% vs. 8%, P=.24), on excluding the patients with cardiogenic shock as a presentation. MACCE were similar in both groups in the out-patient phase (15% vs. 12%, P=.46). Survival without MACCE, general and cardiac death were comparable between groups (log rank, P=.38, P=.44 and P=.16, respectively).

Conclusion: Even though the clinical and peri-procedural risk profile of the PCI patients were higher, the in-hospital and out-hospital efficacy and safety were comparable with CABG.

Keywords: Cirugía de revascularización coronaria; Coronary artery bypass grafting; Efficacy; Eficacia; Intervencionismo coronario percutáneo; Mexico; México; Percutaneous coronary intervention; Safety; Seguridad; Tronco no protegido de coronaria izquierda; Unprotected left main coronary artery.

Publication types

  • Comparative Study
  • Observational Study

MeSH terms

  • Aged
  • Case-Control Studies
  • Coronary Artery Bypass*
  • Coronary Artery Disease / surgery*
  • Female
  • Humans
  • Longitudinal Studies
  • Male
  • Mexico
  • Percutaneous Coronary Intervention / methods*
  • Retrospective Studies
  • Time Factors
  • Treatment Outcome