Related Links
Statistics
| Number of Journals | 8 |
| Number of Issues | 47 |
| Number of Articles | 342 |
| Article View | 77,833 |
| PDF Download | 49,623 |
One year follow-up of unprotected left main coronary artery disease, a prospective cohort study of 139 patients | ||
| Cardiovascular Biomedicine | ||
| Volume 2, Issue 1, September 2022, Pages 6-10 PDF (326.55 K) | ||
| Document Type: original articles | ||
| DOI: 10.18502/cbj.v1i2.10587 | ||
| Authors | ||
| Abbas Andishmand1; Seyedeh Mahdieh Namayandeh* 1, 2; Seyed Jalil Mirhosseini1; Ahmad Masoudi1; Mojtaba Andishmand1 | ||
| 1Yazd Cardiovascular Research Center , Non-communicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran | ||
| 2Center for Healthcare Data Modeling, Department of Biostatistic and Epidemiology, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran | ||
| Abstract | ||
| Objectives: Coronary artery revascularization is the standard treatment for patients with severe left main coronary artery disease (LMCAD). In cases where the patient refuses surgical revascularization or PCI, medical treatment will be the only option. The purpose of this study was to compare the one-year outcomes of patients with (LMCAD) in terms of surgical or medical treatment. Methods: This prospective cohort study was conducted on 139 patients (91 men and 48 women) with severe left main coronary artery disease who were diagnosed by coronary angiography from 1st Mar 2014 to 28th Feb 2014. Patients were followed up for one year as to major adverse cardiac and cerebral events (MACCE) including death, non-fatal myocardial infarction, stroke, and hospitalization. Results: From total of 2661 coronary angiographies, 139 patients (5.2%) with a mean age of 63.2±7.2 years had LMCAD. The mortality rate in the medical treatment group and the surgical group appeared to be 16.7% (6 cases) and 8.7% (9 cases) respectively (p =.156). The rate of stroke in the medical group turned out to be 5.6% (n=2) and in the surgery group 2% (n=2) (p =.27). The rehospitalization rate was 19.4% in the medical treatment group but 4.9% in the surgical group (p =.013). During one year, the survival rate was significantly lower in the medical group than the group undergoing coronary artery bypass graft surgery (58.3% vs. 84.5%) (p =.002). Conclusions: In the short term, the optimal medical treatment of patients with LMCAD was not significantly different from that of CABG patients in terms of fatal cardiac and cerebral events. However, rehospitalization was more common due to recurrent angina pectoris. | ||
| Keywords | ||
| unprotected Left main coronary artery disease (LMCAD); Event-free Survival; Major Cardiac and cerebral events (MACCE) | ||
| References | ||
|
1.Kalbfleisch H, Hort W. Quantitative study on the size of the coronary artery supplying areas postmortem. Am Heart J. 1977; 94(2):183-8.
2.Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG, et al. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery. Circulation. 2011; 124(23):e652-e735.
3.Neumann FJ, Sousa-Uva M, Ahlsson A, et al; ESC Scientific Document Group. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2019 Jan 7;40(2):87-165. doi: 10.1093/eurheartj/ ehy394. Erratum in: Eur Heart J. 2019 Oct 1;40(37):3096. PMID: 30165437.
4.Taggart DP, Kaul S, Boden WE, et al. Revascularization for unprotected left main stem coronary artery stenosis: stenting or surgery. J Am Coll Cardiol 2008; 51(9):885-92.
5.Taylor H, Deumite N, Chaitman B, et al. Asymptomatic left main coronary artery disease in the Coronary Artery Surgery Study (CASS) registry. Circulation. 1989; 79(6):1171-9.
6.Caracciolo EA, Davis KB, Sopko G, et al. Comparison of surgical and medical group survival in patients with left main coronary artery disease: long-term CASS experience. Circulation. 1995; 91:2325–34.
7.Sabik JF, Blackstone EH, Firstenberg M, et al. A benchmark for evaluating innovative treatment of left main coronary disease. Circulation. 2007; 116 (Suppl.I): I232-9.
8. Sung RJ, Mallon SM, Richter SE, Ghahramani AE, et al. Left main coronary artery obstruction. Follow-up of thirty patients with and without surgery. Circulation. 1975; 52(2 Suppl): I112-8.
9.M.S. Lee, P. Bokhoor, S.J. Park, Y.H., et al. Unprotected left main coronary disease and ST-segment elevation myocardial infarction:a contemporary review and argument for percutaneous coronary intervention. JACC Cardiovasc Interv.2010; 3(8):791-5.
10.Morice MC, Serruys PW, Kappetein AP, et al. Outcomes in patients with de novo left main disease treated with either percutaneous coronary intervention using paclitaxel-eluting stents or coronary artery bypass graft treatment in the Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery (SYNTAX) trial. Circulation. 2010; 121(24):2645-53.
11. Gardner TJ, Horneffer PJ, Manolio TA, et al. Stroke following bypass grafting: A ten-year study. Ann Thorac Surg. 1985; 40(6):574-81.
12. Vigneswaran WT, Sapsford RN, Stanbridge RD. Disease of the left main coronary artery: early surgical results and their association with carotid artery stenosis. Br Heart J. 1993; 70(4):342-5.
13. Michael Shih, David Slovut, Yana Etkin, et al. Left Main Coronary Artery Disease as a Predictor of Concomitant Carotid Artery Disease. J Vasc Surg. 2012; 56(3):895.
14. Brener BJ, Brief DK, Alpert J, et al. The risk of stroke in patients with asymptomatic carotid stenosis undergoing cardiac surgery: a follow-up study. J Vasc Surg. 1987; 5: 269- 79.
15.Evagelopoulos N, Trenz MT, Beckmann A, et al. Simultaneous carotid endarterectomy and coronary artery bypass grafting in 313 patients. Cardiovasc Surg. 2000; 8(1):31-40.
16.Ragosta, S. Dee, I.J. Sarembock, L.C. Lipson, L.W. Gimple, E.R. Prevalence of unfavorable angiographic characteristics for percutaneous intervention in patients with unprotected left main coronary artery disease. Catheter Cardiovasc Interv. 2006; 68(3):357-62.
17.Stone GW, Kappetein AP, Sabik JF et al. EXCEL Trial Investigators. Five-Year Outcomes after PCI or CABG for Left Main Coronary Disease. N Engl J Med. 2019; 381(19):1820-1830.
18.Stone GW, Sabik JF, Serruys PWet al. EXCEL Trial Investigators. Everolimus-Eluting Stents or Bypass Surgery for Left Main Coronary Artery Disease. N Engl J Med. 2016; 375(23):2223-2235.
19.ISCHEMIA Trial Research Group, Maron DJ, Hochman JS, O'Brien SM, , et al. International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) trial: Rationale and design. Am Heart J. 2018; 201: 124-135.
20.Brophy JM. Bayesian Interpretation of the EXCEL Trial and Other Randomized Clinical Trials of Left Main Coronary Artery Revascularization. JAMA Intern Med. 2020; 180(7):986-992. | ||
|
Statistics Article View: 110 PDF Download: 60 |
||