Percutaneous Coronary Intervention Versus Coronary Artery Bypass Graftinge Among Patients with Unprotected Left Main Coronary Artery Disease in the New-Generation Drug-Eluting Stents Era (From the CREDO-Kyoto PCI/CABG Registry Cohort-3) - 22/03/21
, Takeshi Morimoto, MD, MPH b, Kazushige Kadota, MD c, Tomohisa Tada, MD d, Yasuaki Takeji, MD a, Yukiko Matsumura-Nakano, MD a, Yusuke Yoshikawa, MD a, Kazuaki Imada, MD e, Takenori Domei, MD e, Kazuhisa Kaneda, MD f, Ryoji Taniguchi, MD g, Natsuhiko Ehara, MD h, Ryuzo Nawada, MD i, Masahiro Natsuaki, MD j, Kyohei Yamaji, MD e, Mamoru Toyofuku, MD k, Naoki Kanemitsu, MD l, Eiji Shinoda, MD m, Satoru Suwa, MD n, Atsushi Iwakura, MD o, Toshihiro Tamura, MD p, Yoshiharu Soga, MD q, Tsukasa Inada, MD r, Mitsuo Matsuda, MD s, Tadaaki Koyama, MD t, Takeshi Aoyama, MD u, Yukihito Sato, MD g, Yutaka Furukawa, MD h, Kenji Ando, MD e, Fumio Yamazaki, MD v, Tatsuhiko Komiya, MD w, Kenji Minatoya, MD x, Yoshihisa Nakagawa, MD y, Takeshi Kimura, MD aOn behalf of the
CREDO-Kyoto PCI/CABG Registry Cohort-3 investigators
Résumé |
Long-term safety of percutaneous coronary intervention (PCI) as compared with coronary artery bypass grafting (CABG) is still controversial in patients with unprotected left main coronary artery disease (ULMCAD), and there is a scarcity of real-world data on the comparative long-term clinical outcomes between PCI and CABG for ULMCAD in new-generation drug-eluting stents era. The CREDO-Kyoto PCI/CABG registry Cohort-3 enrolled 14927 consecutive patients undergoing first coronary revascularization with PCI or isolated CABG between January 2011 and December 2013, and we identified 855 patients with ULMCAD (PCI: N = 383 [45%], and CABG: N = 472 [55%]). The primary outcome measure was all-cause death. Median follow-up duration was 5.5 (interquartile range: 3.9 to 6.6) years. The cumulative 5-year incidence of all-cause death was not significantly different between the PCI and CABG groups (21.9% vs 17.6%, Log-rank p = 0.13). After adjusting confounders, the excess risk of PCI relative to CABG remained insignificant for all-cause death (HR, 1.00; 95% CI, 0.68 to 1.47; p = 0.99). There were significant excess risks of PCI relative to CABG for myocardial infarction and any coronary revascularization (HR, 2.07; 95% CI, 1.30 to 3.37; p = 0.002, and HR, 2.96; 95% CI, 1.96 to 4.46; p < 0.001), whereas there was no significant excess risk of PCI relative to CABG for stroke (HR, 0.85; 95% CI, 0.50 to 1.41; p = 0.52). In conclusion, there was no excess long-term mortality risk of PCI relative to CABG, while the excess risks of PCI relative to CABG were significant for myocardial infarction and any coronary revascularization in the present study population reflecting real-world clinical practice in Japan.
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| Disclosures: Dr. Shiomi reports honoraria from Abbott Vascular, and Boston Scientific. Dr. Morimoto reports honoraria from Bayer and Kowa, and expert witness from Boston Scientific and Sanofi. Dr. Ehara reports honoraria from Abbott Vascular, Bayer, Boston Scientific, Medtronic, and Terumo. Dr. Furukawa reports honoraria from Bayer, Kowa, and Sanofi. Dr. Nakagawa reports research grant from Abbott Vascular and Boston Scientific, and honoraria from Abbott Vascular, Bayer, and Boston Scientific. Dr. Kimura reports honoraria from Abbott Vascular, Astellas, AstraZeneca, Bayer, Boston Scientific, Kowa, and Sanofi. The remaining authors have nothing to disclose. |
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| Funding: This work was supported by an educational grant from the Research Institute for Production Development (Kyoto, Japan). |
Vol 145
P. 47-57 - avril 2021 Retour au numéro
Article précédent
- Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Patients With Versus Without Chronic Kidney Disease
- Ko Yamamoto, Masahiro Natsuaki, Takeshi Morimoto, Hiroki Shiomi, Yasuaki Takeji, Kazushige Kadota, Kazuaki Imada, Mamoru Toyofuku, Naoki Kanemitsu, Eiji Shinoda, Satoru Suwa, Atsushi Iwakura, Toshihiro Tamura, Yoshiharu Soga, Tsukasa Inada, Mitsuo Matsuda, Tadaaki Koyama, Takeshi Aoyama, Eri Kato, Yukihito Sato, Yutaka Furukawa, Kenji Ando, Fumio Yamazaki, Tatsuhiko Komiya, Kenji Minatoya, Yoshihisa Nakagawa, Takeshi Kimura
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