TY - JOUR
T1 - Temporal Trends in Revascularization Strategy and Outcomes in Left Main Coronary Artery Stenosis
T2 - Data from the Asan Medical Center-Left Main Revascularization Registry
AU - Park, Seung Jung
AU - Ahn, Jung Min
AU - Kim, Young Hak
AU - Park, Duk Woo
AU - Yun, Sung Cheol
AU - Yoon, Sung Han
AU - Park, Hyun Woo
AU - Chang, Mineok
AU - Lee, Jong Young
AU - Kang, Soo Jin
AU - Lee, Seung Whan
AU - Lee, Cheol Whan
AU - Park, Seong Wook
N1 - Publisher Copyright:
© 2015 American Heart Association, Inc.
PY - 2015/3/21
Y1 - 2015/3/21
N2 - Background - Changes over time in revascularization strategies and outcomes among patients with unprotected left main coronary artery stenosis remain largely unknown. Methods and Results - A total of 2618 consecutive patients with unprotected left main coronary artery stenosis who underwent revascularization were identified from the ASAN Medical Center-Left MAIN Revascularization registry and classified by time periods: bare metal stent (wave 1, 1995-1998), early drug-eluting stents (wave 2, 2003-2006), and late drug-eluting stents (wave 3, 2007-2010). Primary end point was major adverse cerebrocardiovascular events (the composite of death, myocardial infarction, repeat revascularization, and stroke). During the study period, 1124 patients underwent percutaneous coronary intervention (PCI) and 1494 patients underwent coronary artery bypass grafting. The proportion of PCI significantly increased from 35% to 52% between waves 1 and 3. In patients receiving PCI, the risk-adjusted incidence rate of major adverse cerebro-cardiovascular events decreased from 20.18 cases per 100 person-years in wave 1 to 6.77 cases per 100 person-years in wave 3 (P<0.001 for trend). Death, the composite of death, myocardial infarction, stroke, and repeat revascularization were also significantly decreased by 40%, 35%, and 46%, respectively. The risk-adjusted incidence rate of major adverse cerebrocardiovascular events did not change in patients receiving coronary artery bypass grafting. The difference major adverse cerebrocardiovascular events risk between PCI and coronary artery bypass grafting progressively reduced (adjusted hazard ratio [95% confidence interval], 0.33 [0.23-0.47]; 0.53 [0.35-0.80]; and 1.01 [0.68-1.49] from wave 1 to wave 3. Conclusions - The outcomes of unprotected left main coronary artery PCI have significantly improved over time. In addition, more patients received PCI for unprotected left main coronary artery stenosis in recent years.
AB - Background - Changes over time in revascularization strategies and outcomes among patients with unprotected left main coronary artery stenosis remain largely unknown. Methods and Results - A total of 2618 consecutive patients with unprotected left main coronary artery stenosis who underwent revascularization were identified from the ASAN Medical Center-Left MAIN Revascularization registry and classified by time periods: bare metal stent (wave 1, 1995-1998), early drug-eluting stents (wave 2, 2003-2006), and late drug-eluting stents (wave 3, 2007-2010). Primary end point was major adverse cerebrocardiovascular events (the composite of death, myocardial infarction, repeat revascularization, and stroke). During the study period, 1124 patients underwent percutaneous coronary intervention (PCI) and 1494 patients underwent coronary artery bypass grafting. The proportion of PCI significantly increased from 35% to 52% between waves 1 and 3. In patients receiving PCI, the risk-adjusted incidence rate of major adverse cerebro-cardiovascular events decreased from 20.18 cases per 100 person-years in wave 1 to 6.77 cases per 100 person-years in wave 3 (P<0.001 for trend). Death, the composite of death, myocardial infarction, stroke, and repeat revascularization were also significantly decreased by 40%, 35%, and 46%, respectively. The risk-adjusted incidence rate of major adverse cerebrocardiovascular events did not change in patients receiving coronary artery bypass grafting. The difference major adverse cerebrocardiovascular events risk between PCI and coronary artery bypass grafting progressively reduced (adjusted hazard ratio [95% confidence interval], 0.33 [0.23-0.47]; 0.53 [0.35-0.80]; and 1.01 [0.68-1.49] from wave 1 to wave 3. Conclusions - The outcomes of unprotected left main coronary artery PCI have significantly improved over time. In addition, more patients received PCI for unprotected left main coronary artery stenosis in recent years.
KW - bypass surgery, coronary artery
KW - cerebral revascularization
KW - coronary artery disease
KW - stent
UR - https://www.scopus.com/pages/publications/84929616957
U2 - 10.1161/CIRCINTERVENTIONS.114.001846
DO - 10.1161/CIRCINTERVENTIONS.114.001846
M3 - Article
C2 - 25744763
AN - SCOPUS:84929616957
SN - 1941-7640
VL - 8
JO - Circulation: Cardiovascular Interventions
JF - Circulation: Cardiovascular Interventions
IS - 3
M1 - e001846
ER -
