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Midterm outcome of off-pump bypass procedures versus drug-eluting stent for unprotected left main coronary artery disease

Authors
 Gijong Yi  ;  Young-Nam Youn  ;  Soonchang Hong  ;  Suk-Won Song  ;  Kyung-Jong Yoo 
Citation
 ANNALS OF THORACIC SURGERY, Vol.94(1) : 15-22, 2012 
Journal Title
 ANNALS OF THORACIC SURGERY 
ISSN
 0003-4975 
Issue Date
2012
MeSH
Aged ; Coronary Artery Bypass, Off-Pump* ; Coronary Artery Disease/complications ; Coronary Artery Disease/surgery* ; Drug-Eluting Stents* ; Female ; Humans ; Male ; Middle Aged ; Treatment Outcome
Keywords
Aged ; Coronary Artery Bypass, Off-Pump* ; Coronary Artery Disease/complications ; Coronary Artery Disease/surgery* ; Drug-Eluting Stents* ; Female ; Humans ; Male ; Middle Aged ; Treatment Outcome
Abstract
BACKGROUND: Although surgical revascularization is recommended for the treatment of left main coronary artery (LMCA) disease, percutaneous coronary intervention (PCI) attempts have increased, especially after the introduction of the drug-eluting stent. The goal of this study was to compare the midterm outcomes between drug-eluting stenting and off-pump coronary artery bypass (OPCAB) grafting in LMCA disease. METHODS: Five hundred twelve consecutive patients with unprotected LMCA disease who underwent OPCAB (N = 269) or drug-eluting stenting (N = 243) were enrolled. We compared major cardiac and cerebrovascular events (MACCEs) in a real-world cohort and in a matching patient cohort (N = 256). The duration of mean follow-up was 38 ± 20 months, and the follow-up rate was 97.7%. RESULTS: In a real-world comparison, the OPCAB group showed better 5-year freedom from MACCEs compared with the stenting group (71.5% ± 4.4% versus 67.6% ± 4.0%; p = 0.031), despite worse patient characteristics. After patient matching, the OPCAB group showed more distinct benefit in 5-year freedom from MACCEs (75.3% ± 6.6% versus 62.8% ± 5.4; p < 0.001), including a significantly lower target vessel revascularization (TVR) rate (p < 0.001). In a subgroup analysis, the benefit of OPCAB regarding 5-year freedom from MACCEs was more clearly defined for lesions of the distal LCMA and in LMCA lesions with multivessel disease (p = 0.015, p = 0.004, respectively). CONCLUSIONS: Patients with LMCA disease who were treated with OPCAB showed better 5-year freedom from MACCEs in a real-world practice and in a patient matching cohort compared with the drug-eluting stenting group. TVR was the main factor that made the difference. The benefit of OPCAB was more prominent in distal LMCA lesions and in LMCA lesions with multivessel involvement.
Full Text
http://www.sciencedirect.com/science/article/pii/S0003497512006467
DOI
22542069
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
Yonsei Authors
Song, Suk Won(송석원) ORCID logo https://orcid.org/0000-0002-9850-9707
Yoo, Kyung Jong(유경종) ORCID logo https://orcid.org/0000-0002-9858-140X
Youn, Young Nam(윤영남)
Yi, Gi Jong(이기종)
Hong, Soon Chang(홍순창)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/89568
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