دورية أكاديمية
Real-World Examination of Revascularization Strategies for Left Main Coronary Disease in Ontario, Canada.
| العنوان: | Real-World Examination of Revascularization Strategies for Left Main Coronary Disease in Ontario, Canada. |
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| المؤلفون: | Tam DY; Division of Cardiac Surgery, Department of Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada., Fang J; ICES, Toronto, Ontario, Canada., Rocha RV; Division of Cardiac Surgery, Department of Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada., Rao SV; Division of Cardiology, Durham VA Health System, Duke University Health System, Durham, North Carolina, USA., Dzavik V; Division of Cardiology, Department of Medicine, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada., Lawton J; Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University, Baltimore, Maryland, USA., Austin PC; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada., Gaudino M; Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, New York, USA., Fremes SE; Division of Cardiac Surgery, Department of Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada., Lee DS; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada. Electronic address: dlee@ices.on.ca. |
| المصدر: | JACC. Cardiovascular interventions [JACC Cardiovasc Interv] 2023 Feb 13; Vol. 16 (3), pp. 277-288. Date of Electronic Publication: 2023 Jan 04. |
| نوع المنشور: | Journal Article; Observational Study; Research Support, Non-U.S. Gov't |
| اللغة: | English |
| بيانات الدورية: | Publisher: Elsevier Country of Publication: United States NLM ID: 101467004 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1876-7605 (Electronic) Linking ISSN: 19368798 NLM ISO Abbreviation: JACC Cardiovasc Interv Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: New York : Elsevier |
| مواضيع طبية MeSH: | Coronary Artery Disease*/diagnostic imaging , Coronary Artery Disease*/therapy , Percutaneous Coronary Intervention*/adverse effects, Aged ; Female ; Humans ; Male ; Coronary Artery Bypass/adverse effects ; Ontario ; Treatment Outcome |
| مستخلص: | Background: Randomized trials have compared percutaneous coronary intervention and coronary artery bypass grafting (CABG) in patients with left main coronary artery disease undergoing nonemergent revascularization. However, there is a paucity of real-world contemporary observational studies comparing percutaneous coronary intervention (PCI) and CABG. Objectives: The purpose of this study was to compare the long-term clinical outcomes of CABG versus PCI in patients with left main coronary disease. Methods: Clinical and administrative databases for Ontario, Canada, were linked to obtain records of all patients with angiographic evidence of left main coronary artery disease (≥50% stenosis) treated with either isolated CABG or PCI from 2008 to 2020. Emergent, cardiogenic shock, and ST-segment elevation myocardial infarction patients were excluded. Baseline characteristics of patients were compared and 1:1 propensity score matching was performed. Late mortality and major adverse cardiac and cerebrovascular events were compared between the matched groups using a Cox proportional hazard model. Results: After exclusions, 1,299 and 21,287 patients underwent PCI and CABG, respectively. Prior to matching, PCI patients were older (age 75.2 vs 68.0 years) and more likely to be women (34.6% vs 20.1%), although they had less CAD burden. Propensity score matching on 25 baseline covariates yielded 1,128 well-matched pairs. There was no difference in early mortality between PCI and CABG (5.5% vs 3.9%; P = 0.075). Over 7-year follow-up, all-cause mortality (53.6% vs 35.2%; HR: 1.63; 95% CI: 1.42-1.87; P < 0.001) and major adverse cardiac and cerebrovascular events (66.8% vs 48.6%; HR: 1.77; 95% CI: 1.57-2.00) were significantly higher with PCI than CABG. Conclusions: CABG was the most common revascularization strategy in this real-world registry. Patients undergoing PCI were much older and of higher risk at baseline. After matching, there was no difference in early mortality but improved late survival and freedom from major adverse cardiac and cerebrovascular events with CABG. Competing Interests: Funding Support and Author Disclosures This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and the Ministry of Long-Term Care. This study also received funding from a Foundation grant from the Canadian Institutes of Health Research (grant FDN 148446) and the Ted Rogers Centre for Heart Research. The authors acknowledge that the clinical registry data used in this analysis are from participating hospitals through CorHealth Ontario, which serves as an advisory body to the Ontario Ministry of Health, is funded by the MOH, and is dedicated to improving the quality, efficiency, access, and equity in the delivery of the continuum of adult cardiac and stroke care in Ontario, Canada. Dr Lee has served as the Ted Rogers Chair in Heart Function Outcomes, University Health Network, University of Toronto. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. (Copyright © 2023. Published by Elsevier Inc.) |
| التعليقات: | Comment in: JACC Cardiovasc Interv. 2023 Feb 13;16(3):289-291. (PMID: 36609039) Comment in: JACC Cardiovasc Interv. 2023 Apr 24;16(8):1000. (PMID: 37100547) Comment in: JACC Cardiovasc Interv. 2023 Apr 24;16(8):1001. (PMID: 37100548) |
| معلومات مُعتمدة: | FDN 148446 Canada CIHR |
| فهرسة مساهمة: | Keywords: CABG; PCI; left main coronary disease; revascularization |
| تواريخ الأحداث: | Date Created: 20230107 Date Completed: 20230222 Latest Revision: 20230508 |
| رمز التحديث: | 20240628 |
| DOI: | 10.1016/j.jcin.2022.10.016 |
| PMID: | 36609048 |
| قاعدة البيانات: | MEDLINE |
Full Text via ClinicalKey 
Full Text Finder | تدمد: | 1876-7605 |
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| DOI: | 10.1016/j.jcin.2022.10.016 |