Outcomes of patients with left main coronary artery disease undergoing medical or surgical treatment: a propensity- matched analysis
Outcomes of patients with left main coronary artery disease undergoing medical or surgical treatment: a propensity- matched analysis
Data
2011
Autores
De Lorenzo, Andrea
Tura, Bernardo
Bassan, Fernando
Pittella, Felipe
Rocha, Antonio Sergio C
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Publisher
Coronary Artery Disease
Resumo
Objective: To evaluate the outcomes of patients with significant (≥ 50%) left main coronary artery disease (LMCAD) undergoing medical treatment (MT) or coronary artery bypass grafting surgery (CABG).
Methods: A total of 181 patients with significant LMCAD were followed for 4 ± 2 years. MT was done when patients refused CABG or because of either thin native vessels or high clinical risk. Events were defined as all-cause death, myocardial infarction, percutaneous coronary intervention, or subsequent CABG. Logistic regression analysis was used to identify independent predictors of death. A propensity score was created to compare outcomes of patients from the two treatment groups.
Results: CABG was performed in 78.5% of the patients. Overall, there were no significant differences in the incidences of death or other events between treatment groups. In patients with normal left ventricular (LV) function (ejection fraction, ≥ 45%), there were no significant differences in event rates with MT or CABG (death, 7.7 vs. 12.1%; myocardial infarction, 0 vs. 1.9%; percutaneous coronary intervention, 3.8 vs. 5.6%). For patients with LV dysfunction, death was more frequent with MT than with CABG (53.8 vs. 22.9%, P<0.001), whereas the incidence of other events was not statistically different. Age and LV dysfunction, but not treatment type, were independent predictors of death. When comparing propensity-matched patients from both treatment groups, there was also no difference in survival.
Conclusion: Patients with 50% or more LMCAD and LV dysfunction had increased survival with CABG. However, outcomes of patients with 50% or more LMCAD and normal LV function were not significantly different with either MT or CABG.
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De Lorenzo A, Tura B, Bassan F, Pittella F, Rocha AS. Outcomes of patients with left main coronary artery disease undergoing medical or surgical treatment: a propensity-matched analysis. Coron Artery Dis. 2011 Dec;22(8):585-9. doi: 10.1097/MCA.0b013e32834c7501.