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Rates and Independent Correlates of 10-Year Major Adverse Events and Mortality in Patients Undergoing Left Main Coronary Arterial Revascularization

Published:January 29, 2020DOI:https://doi.org/10.1016/j.amjcard.2020.01.023
      Patients who underwent myocardial revascularization for significant left main coronary artery disease (LMCA) are at high risks of ischemic events and death during follow-up. We sought to determine the independent correlates for very long-term outcomes after LMCA revascularization, which would be clinical value for risk stratification in such high-risk patients. The 10-year rates of clinical outcomes and independent correlates of adverse events were evaluated in 2,240 patients with LMCA disease in the MAIN-COMPARE registry, including 1,102 patients who underwent stenting and 1,138 who underwent coronary artery bypass grafting. The primary outcome was the composite of all-cause death, Q-wave myocardial infarction, or stroke. Secondary outcomes were all-cause mortality and target-vessel revascularization (TVR). The 10-year rates of the primary composite outcome, all-cause mortality, and TVR were 24.7%, 22.2%, and 13.6%, respectively. Age >65 years, diabetes, previous heart failure, cerebrovascular disease, peripheral arterial disease, chronic renal failure, atrial fibrillation, ejection fraction <40%, and distal LMCA bifurcation disease were independent correlates of the primary outcome in the overall population. Several clinical and anatomic parameters were also identified as independent correlates of all-cause death and TVR. Interaction analysis showed no heterogeneities of the effects of variables depending on revascularization type. These clinical descriptors can assist clinicians in identifying high-risk patients within the broad range of risk for patients who underwent LMCA revascularization.
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      References

        • Palmerini T
        • Serruys P
        • Kappetein AP
        • Genereux P
        • Riva DD
        • Reggiani LB
        • Christiansen EH
        • Holm NR
        • Thuesen L
        • Makikallio T
        • Morice MC
        • Ahn JM
        • Park SJ
        • Thiele H
        • Boudriot E
        • Sabatino M
        • Romanello M
        • Biondi-Zoccai G
        • Cavalcante R
        • Sabik JF
        • Stone GW
        Clinical outcomes with percutaneous coronary revascularization vs coronary artery bypass grafting surgery in patients with unprotected left main coronary artery disease: a meta-analysis of 6 randomized trials and 4,686 patients.
        Am Heart J. 2017; 190: 54-63
        • Park DW
        • Ahn JM
        • Park SJ
        • Taggart DP
        Percutaneous coronary intervention in left main disease: SYNTAX, PRECOMBAT, EXCEL and NOBLE-combined cardiology and cardiac surgery perspective.
        Ann Cardiothorac Surg. 2018; 7: 521-526
        • Boudriot E
        • Thiele H
        • Walther T
        • Liebetrau C
        • Boeckstegers P
        • Pohl T
        • Reichart B
        • Mudra H
        • Beier F
        • Gansera B
        • Neumann FJ
        • Gick M
        • Zietak T
        • Desch S
        • Schuler G
        • Mohr FW
        Randomized comparison of percutaneous coronary intervention with sirolimus-eluting stents versus coronary artery bypass grafting in unprotected left main stem stenosis.
        J Am Coll Cardiol. 2011; 57: 538-545
        • Seung KB
        • Park DW
        • Kim YH
        • Lee SW
        • Lee CW
        • Hong MK
        • Park SW
        • Yun SC
        • Gwon HC
        • Jeong MH
        • Jang Y
        • Kim HS
        • Kim PJ
        • Seong IW
        • Park HS
        • Ahn T
        • Chae IH
        • Tahk SJ
        • Chung WS
        • Park SJ
        Stents versus coronary-artery bypass grafting for left main coronary artery disease.
        N Engl J Med. 2008; 358: 1781-1792
        • Park DW
        • Seung KB
        • Kim YH
        • Lee JY
        • Kim WJ
        • Kang SJ
        • Lee SW
        • Lee CW
        • Park SW
        • Yun SC
        • Gwon HC
        • Jeong MH
        • Jang YS
        • Kim HS
        • Kim PJ
        • Seong IW
        • Park HS
        • Ahn T
        • Chae IH
        • Tahk SJ
        • Chung WS
        • Park SJ
        Long-term safety and efficacy of stenting versus coronary artery bypass grafting for unprotected left main coronary artery disease: 5-year results from the MAIN-COMPARE (Revascularization for Unprotected Left Main Coronary Artery Stenosis: Comparison of Percutaneous Coronary Angioplasty Versus Surgical Revascularization) registry.
        J Am Coll Cardiol. 2010; 56: 117-124
        • Park DW
        • Ahn JM
        • Yun SC
        • Yoon YH
        • Kang DY
        • Lee PH
        • Lee SW
        • Park SW
        • Seung KB
        • Gwon HC
        • Jeong MH
        • Jang Y
        • Kim HS
        • Seong IW
        • Park HS
        • Ahn T
        • Chae IH
        • Tahk SJ
        • Park SJ
        10-year outcomes of stents versus coronary artery bypass grafting for left main coronary artery disease.
        J Am Coll Cardiol. 2018; 72: 2813-2822
        • Stone GW
        • Kappetein AP
        • Sabik JF
        • Pocock SJ
        • Morice MC
        • Puskas J
        • Kandzari DE
        • Karmpaliotis D
        • Brown 3rd, WM
        • Lembo NJ
        • Banning A
        • Merkely B
        • Horkay F
        • Boonstra PW
        • van Boven AJ
        • Ungi I
        • Bogats G
        • Mansour S
        • Noiseux N
        • Sabate M
        • Pomar J
        • Hickey M
        • Gershlick A
        • Buszman PE
        • Bochenek A
        • Schampaert E
        • Page P
        • Modolo R
        • Gregson J
        • Simonton CA
        • Mehran R
        • Kosmidou I
        • Genereux P
        • Crowley A
        • Dressler O
        • Serruys PW
        Five-year outcomes after PCI or CABG for left main coronary disease.
        N Engl J Med. 2019; 381: 1820-1830
        • Holm NR
        • Makikallio T
        • Lindsay MM
        • Spence MS
        • Erglis A
        • Menown IBA
        • Trovik T
        • Kellerth T
        • Kalinauskas G
        • Mogensen LJH
        • Nielsen PH
        • Niemela M
        • Lassen JF
        • Oldroyd K
        • Berg G
        • Stradins P
        • Walsh SJ
        • Graham ANJ
        • Endresen PC
        • Frobert O
        • Trivedi U
        • Anttila V
        • Hildick-Smith D
        • Thuesen L
        • Christiansen EH
        Percutaneous coronary angioplasty versus coronary artery bypass grafting in the treatment of unprotected left main stenosis: updated 5-year outcomes from the randomised, non-inferiority NOBLE trial.
        Lancet. 2020; 395: 191-199
        • Fihn SD
        • Blankenship JC
        • Alexander KP
        • Bittl JA
        • Byrne JG
        • Fletcher BJ
        • Fonarow GC
        • Lange RA
        • Levine GN
        • Maddox TM
        • Naidu SS
        • Ohman EM
        • Smith PK
        2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons.
        J Am Coll Cardiol. 2014; 64: 1929-1949
        • Neumann FJ
        • Sousa-Uva M
        • Ahlsson A
        • Alfonso F
        • Banning AP
        • Benedetto U
        • Byrne RA
        • Collet JP
        • Falk V
        • Head SJ
        • Juni P
        • Kastrati A
        • Koller A
        • Kristensen SD
        • Niebauer J
        • Richter DJ
        • Seferovic PM
        • Sibbing D
        • Stefanini GG
        • Windecker S
        • Yadav R
        • Zembala MO
        2018 ESC/EACTS Guidelines on myocardial revascularization.
        Eur Heart J. 2019; 40: 87-165
        • Farooq V
        • Vergouwe Y
        • Raber L
        • Vranckx P
        • Garcia-Garcia H
        • Diletti R
        • Kappetein AP
        • Morel MA
        • de Vries T
        • Swart M
        • Valgimigli M
        • Dawkins KD
        • Windecker S
        • Steyerberg EW
        • Serruys PW
        Combined anatomical and clinical factors for the long-term risk stratification of patients undergoing percutaneous coronary intervention: the logistic clinical SYNTAX score.
        Eur Heart J. 2012; 33: 3098-3104
        • Ranucci M
        • Castelvecchio S
        • Menicanti L
        • Frigiola A
        • Pelissero G
        Risk of assessing mortality risk in elective cardiac operations: age, creatinine, ejection fraction, and the law of parsimony.
        Circulation. 2009; 119: 3053-3061
        • Farooq V
        • Serruys PW
        • Bourantas C
        • Vranckx P
        • Diletti R
        • Garcia Garcia HM
        • Holmes DR
        • Kappetein AP
        • Mack M
        • Feldman T
        • Morice MC
        • Colombo A
        • Morel MA
        • de Vries T
        • van Es GA
        • Steyerberg EW
        • Dawkins KD
        • Mohr FW
        • James S
        • Stahle E
        Incidence and multivariable correlates of long-term mortality in patients treated with surgical or percutaneous revascularization in the synergy between percutaneous coronary intervention with taxus and cardiac surgery (SYNTAX) trial.
        Eur Heart J. 2012; 33: 3105-3113