Investigation of Patients Undergoing Left Main Coronary Stent Implantation in Our Center for Major Adverse Cardiac Events

Abstract

Objective: Despite many studies in the literature, there is no definite decision in the treatment of the patients who diagnosed critical stenosis in the left main coronary artery. We aimed to retrospectively scan the patients who underwent left main coronary artery stent implantation in our center in the last five years, compare them with the patients who underwent coronary artery bypass graft, and share the results of our own center. Materials and Methods: Patients with suspected coronary artery disease who underwent invasive coronary angiography as a result of various tests and underwent stent implantation due to left main coronary artery critical stenosis (31 patients) and coronary artery bypass graft, due to left main coronary stenosis or three-vessel disease (34 patients) were included in the study. Patients were compared in terms of death, stroke, myocardial infarction, and revascularization. Results: While the mean age was 68.77±11.46 years in the percutaneous coronary intervention group and 72.82±8.81 years in the coronary artery bypass graft group (p 0.110). Demographic data of the two groups were similar and no significant difference was found between the groups. A statistically significant difference was found between the two groups in terms of use calcium channel blockers (p 0.049) and clopidogrel (p 0.001). No statistically significant difference was observed between the groups in terms of stroke (P 0.981), need for revascularization (0.614), death (P 0.21), and myocardial infarction (0.071). Conclusion: There is no difference in the application of percutaneous coronary intervention and coronary artery bypass graft in patients with left main coronary artery lesions in terms of stroke, revascularization, death and myocardial infarction. Further studies with larger cohorts are needed for validation.

Keywords

• CABG
• PCI
• mortality

Merkezimizde Sol Ana Koroner Stent İmplantasyonu Uygulanan Hastaların Major Advers Kardiyak Olaylar Açısından İncelenmesi

Abstract

Giriş ve Amaç: Literatürde yer alan birçok çalışmaya rağmen sol ana koroner arterde kritik darlık saptanan hastaların tedavisinde kesin olarak varılan bir karar bulunmamaktadır. Merkezimizde son beş yıl içerisinde sol ana koroner arter stent implantasyonu yapılan hastaları retrospektif olarak tarayarak koroner arter bypass greft uygulanan hastalar ile kıyaslayıp kendi merkezimizin sonuçlarını paylaşmayı hedefledik. Gereç ve Yöntemler: Koroner arter hastalığı şüphesiyle çeşitli testler sonucunda invaziv koroner anjiyografi uygulanıp sol ana koroner arter kritik darlığı nedeniyle stent implantasyonu (31 hasta) ve ana koroner darlığı ya da üç damar hastalığı nedeniyle bypass kararı verilen (34 hasta) hastalar çalışmaya dahil edildi. Ölüm, inme, miyokart enfarktüsü, tekrarlayan revaskülarizasyon açısından hastalar kıyaslandı. Bulgular: Perkutan koroner girişim grubunda ortalama yaş 68,77±11,46, koroner arter bypass greft grubunda ise 72,82±8,81 olarak izlenmişken p değeri 0,110 olarak saptanmıştır. İki grubun demografik verileri benzer olup gruplar arasında anlamlı fark saptanmamıştır. İki grup arasında kalsiyum kanal blokörü (p 0.049) ve klopidogrel (p 0.001) kullanımı açısından istatistiki anlamlı fark saptanmıştır. Gruplar arasında inme (P 0,981), tekrarlayan revaskülarizasyon ihtiyacı (0,614), ölüm (P 0,21) ve miyokart enfarktüsü (0,071) açısından istatistiki açıdan anlamlı bir fark gözlenmemiştir. Sonuç: Sol ana koroner arter lezyonu olan hastalarda perkutan koroner girişim ve koroner arter bypass greft uygulanmasında inme, tekrarlan revaskülarizasyon, ölüm ve miyokart enfarktüsü açısından fark yoktur.

Keywords

• CABG
• PCI
• mortalite

References

1. Sarnak, M.J, Levey, A.S, Schoolwerth, A.C, Coresh, J, Culleton, B, Hamm, L.L, et al., Kidney disease as a risk factor for development of cardiovascular disease: A statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention, Circulation, 2003, 108, 2154 –2169.
2. Stuart, J.H, Sanjay, K, Michael, J.M, Patrick, W.S, Taggart, D.P, Holmes, D.R, et al., The rationale for Heart Team decision-making for patients with stable, complex coronary artery disease, European Heart Journal, 2013, 34, 2510–2518.
3. Serruys, P.W, Morice, M.C, Kappetein, A.P, Colombo, A, Holmes, D.R, Mack, M.J, et al., Percutaneous coronary intervention versus coronary- artery bypass grafting for severe coronary artery disease, New England Journal of Medicine, 2009, 360, 961–972.
4. Dangas, G.D, Claessen, B.E, Caixeta, A, Sanidas, E.A, Mintz, G.S, Mehran, R, In-stent restenosis in the drug- eluting stent era, Journal of the American College of Cardiology, 2010, 56, 1897–907.
5. Giustino, G, Chieffo, A, Palmerini, T, Valgimigli, M, Feres, F, Abizaid, A, et al., Efficacy and safety of dual antiplatelet therapy after complex PCI, Journal of the American College of Cardiology, 2016, 68, 1851–1864.
6. Piccolo, R, Giustino, G, Mehran, R, Windecker S, Stable coronary artery disease: revascularisation and invasive strategies, Lancet, 2015, 386, 702–713.
7. Verma, S, Farkouh, M.E, Yanagawa, B, Fitcheed, D.H, Ahsan, M.R, Ruel, M, et al., Comparison of coronary artery bypass surgery and percutaneous coronary intervention in patients with diabetes: a meta-analysis of randomized controlled trials, Lancet, Diabetes Endocrinology, 2013, 1, 317–328.
8. Hlatky, M.A, Boothroyd, D.B, Bravata, D.M, Boersma, E, Booth, J, Brooks, M.M, et al., Coronary artery bypass surgery compared with percutaneous coronary interventions for multivessel disease: a collaborative analysis of individual patient data from ten randomised trials, Lancet, 2009, 373, 1190–1197.

9. Milojevic, M, Serruys, P.W, Sabik, J.S, Kandzari, D.E, Schampaert, E, Boven, A.J.V, et al., Bypass Surgery or Stenting for Left Main Coronary Artery Disease in Patients With Diabetes, Journal of the American College of Cardiology, 2019, 13, 1016-1028.
10. Stone, G.W, Sabik, J.F, Serruys, P.W, Simonton, C.A, Genereux, P, Puskas, J, et al., EXCEL Trial Investigators. Everolimus-eluting stents or bypass surgery for left main coronary artery disease, New England Journal of Medicine, 2016, 375, 2223–2230.
11. Jung, M.A, Jae, H.R, Young, H.K., Duk, W.P, Sung, C.Y, Lee, P.H, et al., Randomized Trial of Stents Versus Bypass Surgery for Left Main Coronary Artery Disease 5-Year Outcomes of the PRECOMBAT Study, Journal of the American College of Cardiology, 2020, 26, 2198-206.
12. Stuart, J.H, Milojevic, M, Daemen, J, Ahn, J.M, Boersma, E, Christiansen, E.H, et al., Mortality after coronary artery bypass grafting versus percutaneous coronary intervention with stenting for coronary artery disease: a pooled analysis of individual patient data, Lancet, 2018, 391, 939–948.
13. Morice, M.C, Serruys, P.W, Kappetein, A.P, Feldman, T.E, Stahle, E, Colombo, A, et al., Outcomes in patients with de novo left main disease treated with either percutaneous coronary intervention using paclitaxeleluting stents or coronary artery bypass graft treatment in the Synergy Between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery (SYNTAX) trial, Circulation, 2010, 121, 2645-2653.
14. Gennaro, G, Patrick, W.S, Joseph, F.S, Roxana, M, Akiko, M, Puskas, J.D, et al., Mortality After Repeat Revascularization Following PCI or CABG for Left Main Disease, Journal of the American College of Cardiology Cardiovasc Interventions, 2020, 10, 13(3), 375-387.
15. Gündüz, R, Usalp, S, Genç Kalp Krizlerinde Klinik, Laboratuvar ve Anjiyografi Özellikleri: Çok Merkezli Retrospektif Çalışma, Celal Bayar Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi, 2022, 9(1), 126-130.
16. Park, S.J, Ahn, J.M, Kim .H, Park, D.W, Yun, S.C, Lee, J.Y, et al., Trial of everolimus-eluting stents or bypass surgery for coronary disease, New England Journal of Medicine, 2015, 372, 1204–1212.
17. Farkouh, M.E, Domanski, M, Sleeper, L.A, Siami, F.S, Dangas, G, Mack, M, et al., Strategies for multivessel revascularization in patients with diabetes, New England Journal of Medicine, 2012, 367, 2375–2384.
18. Mack, M, Holmes, D.R, Randomised trials in left main disease: a NOBLE effort, Lancet, 2016, 388, 2715-2716.
19. Balmer, F, Rotter, M, Togni, M, Pfiffner, D, Zeiher, A.M, Maier, W, Meier, B, Working Group Interventional Cardiology and Coronary Pathophysiology of the European Society of Cardiology, Percutaneous coronary interventions in Europe 2000, International Journal of Cardiology, 2005, 101, 457–463.
20. OECD, Health at a Glance 2009, OECD Publishing.
21. Hillis, L.D, Smith, P.K, Anderson, J.L et al., 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, Circulation, 2011, 124, 2610–2642.