Percutaneous versus surgical revascularization of unprotected left main coronary artery: Data from the Portuguese Registry of Acute Coronary Syndromes (ProACS)

被引:1
作者
Pereira, Ana Rita [1 ]
Cale, Rita [1 ]
Briosa, Alexandra [1 ]
Santos, Joao Grade
Sebaiti, Daniel [1 ]
Martinho, Mariana [1 ]
Ferreira, Barbara
Marques, Ana [1 ]
Alegria, Sofia [1 ]
Gomes, Ana Catarina [1 ]
Morgado, Goncalo
Martins, Ana Cristina [1 ,2 ,3 ]
Pereira, Helder
机构
[1] Hosp Garcia Orta, Dept Cardiol, Almada, Portugal
[2] Univ Lisbon, Cardiovasc Ctr, Lisbon, Portugal
[3] Univ Lisbon, Fac Med, Acad Med Ctr Lisbon, Lisbon, Portugal
关键词
Unprotected left main coronary artery; Acute coronary syndrome; Percutaneous coronary intervention; Coronary artery; bypass grafting; ACUTE MYOCARDIAL-INFARCTION; PACLITAXEL-ELUTING STENTS; BYPASS-SURGERY; 5-YEAR OUTCOMES; TASK-FORCE; CLINICAL-OUTCOMES; HEART-ASSOCIATION; AMERICAN-COLLEGE; RANDOMIZED-TRIAL; INTERVENTION;
D O I
10.1016/j.repc.2022.07.019
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: In acute coronary syndromes (ACS), the optimal revascularization strategy for unprotected left main coronary artery (ULMCA) culprit lesion has been under-investigated. Therefore, we compared clinical characteristics and short-and medium-term outcomes of percutaneous and surgical revascularization in ACS. Methods and results: Of 31 886 patients enrolled in a multicenter, national, prospective registry study between October 2010 and December 2020, 246 (0.8%) had ULMCA as a culprit lesion and underwent percutaneous coronary intervention (PCI) alone (n=133, 54%) or coronary artery bypass grafting (CABG) alone (n=113, 46%). Patients undergoing PCI presented more frequently ongoing chest pain (68% versus 41%, p<0.001) and cardiogenic shock (25% versus 1%, p<0.001). Time from admission to revascularization was higher in surgical group with a median time to CABG of 4.5 days compared to 0 days to PCI (p<0.001). Angiographic success rate was 93.2% in patients who underwent PCI. Primary endpoint (all-cause death, non-fatal reinfarction and/or non-fatal stroke during hospitalization) occurred in 15.9% of patients and was more frequent in the PCI group (p<0.001). After adjustment, surgical revascularization was associated with better in-hospital prognosis (odds ratio (OR) 0.164; 95% confidence interval (CI), 0.04-0.64; p=0.009). Similar results were achieved after propensity score matching. No difference was found at one-year all-cause death.
引用
收藏
页码:529 / 539
页数:11
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