Acute and Late Outcomes of Unprotected Left Main Stenting in Comparison With Surgical Revascularization
Pawel E. Buszman, MD, FACC*, ,*,
Stefan R. Kiesz, MD, FACC ,,
Andrzej Bochenek, MD*,
Ewa Peszek-Przybyla, MD ,
Iwona Szkrobka, MD,
Marcin Debinski, MD,
Bozena Bialkowska, MD,
Dariusz Dudek, MD||,
Agata Gruszka, MD,
Aleksander Zurakowski, MD,
Krzysztof Milewski, MD,
Miroslaw Wilczynski, MD,
Lukasz Rzeszutko, MD||,
Piotr Buszman*,
Jan Szymszal, PhD¶,
Jack L. Martin, MD, FACC# and
Michal Tendera, MD, FACC*
* Medical University of Silesia, Katowice, Poland
San Antonio Endovascular and Heart Institute, University of Texas Health Science Center at San Antonio, San Antonio, Texas
American Heart of Poland, Ustron, Poland
Upper-Silesian Heart Centre, Katowice, Poland
|| Jagiellonian University, Krakow, Poland
¶ Silesian School of Engineering, Katowice, Poland
# Bryn Mawr and Thomas Jefferson University, Philadelphia, Pennsylvania.
View larger version (31K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 1 Experimental Design of the Study
Three hundred and forty-seven patients with unprotected left main (UPLM) disease were screened. Patients who were eligible for the study and signed informed consent (105 patients) were randomized to both treatment arms. Seventeen patients were not randomized due to their refusal. Patients not eligible for the study were included in the LE MANS registry. CABG = coronary artery bypass grafting; PCI = percutaneous coronary intervention.
|
|
View larger version (34K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 2 LVEF in PCI and CABG Groups at Baseline and After 12 Months
There was no significant difference in LVEF between the groups at baseline (p = 0.22). After 1 year, LVEF improved significantly in the PCI group (p = 0.04) but did not in the CABG group (p = 0.85). There was a significant difference in LVEF between the groups after 12 months (p = 0.01). CI = confidence interval; LVEF = left ventricular ejection fraction; SD = standard deviation; other abbreviations as in Figure 1.
|
|
View larger version (19K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 3 CCS Functional Class at Baseline and Follow-Up
At the same time points, angina status based on Canadian Cardiovascular Society (CCS) classification was maintained through 12 months of observation. Patients after PCI had more angina after 1 month and after 6 months (Mann-Whitney U test: p = 0.01) but had similar rates of angina as CABG patients after 12 months (p = 0.11). ANOVA = analysis of variance; other abbreviations as in Figures 1 and 2.
|
|
View larger version (17K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 4 Results of Treadmill Stress Tests After PCI and CABG
Patients after PCI and CABG performed equally well on treadmill stress tests with an exception of the first month post-procedure, when patients after PCI performed better. METs = metabolic equivalents; other abbreviations as in Figures 1 and 2.
|
|
View larger version (12K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 5 Survival After PCI and CABG
According to Kaplan-Meier analysis, there was a trend toward better long-term survival after PCI (F-Cox test: p = 0.081). Abbreviations as in Figure 1.
|
|
View larger version (14K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 6 MACCE-Free Survival After PCI and CABG
Long-term MACCE-free survival did not differ significantly between the groups (53.9% vs. 56.6%, respectively; F-Cox test: p = 0.47). MACCE = major adverse cardiac and cerebrovascular events; other abbreviations as in Figure 1.
|
|
|
