AS-209: Complete 10-Year Outcomes after Stent Implantation versus Coronary Artery Bypass Grafting for Unprotected Left Main Coronary Artery Disease

AS-209: Complete 10-Year Outcomes after Stent Implantation versus Coronary Artery Bypass Grafting for Unprotected Left Main Coronary Artery Disease

Wednesday, April 28 - Friday, April 30, 2010 (E-Poster Abstract Zone) Miscellaneous (Abstract nos. AS-208 –AS-234) Conclusion: A SYNTAX score appear...

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Wednesday, April 28 - Friday, April 30, 2010 (E-Poster Abstract Zone)

Miscellaneous (Abstract nos. AS-208 –AS-234)

Conclusion: A SYNTAX score appears to be associated with the risk of MACE after stenting for ULMCA stenosis. However, the differential effectiveness of stenting versus CABG in the risk of MACE or MACCE seems to be independent of the SYNTAX score classifications.

AS-209 AS-208 Validity of the SYNTAX Score in Predicting Long-Term Adverse Outcomes after Revascularization for Unprotected Left Main Coronary Artery Stenosis in the MAIN-COMPARE Registry. Seung-Jung Park, Young-Hak Kim, Jong-Young Lee, Won-Jang Kim, Soo-Jin Kang, Duk-Woo Park, Seung-Whan Lee, Cheol Whan Lee, Jae-Joong Kim, Seong-Wook Park. Asan Medical Center, Seoul, Republic of Korea. Background: A comprehensive angiographic scoring system, the SYNTAX score, was developed to help physicians predict long-term outcome or select a revascularization strategy. However, its validity has not been systemically evaluated for patients with unprotected left main coronary artery (ULMCA) stenosis. Methods: From 2240 patients who received either stenting or coronary artery bypass graft (CABG) surgery for ULMCA stenosis enrolled in the MAIN–COMPARE registry, the SYNTAX-score was analyzed in angiographic core laboratory for 1580 (70.5%) patients including 819 receiving stenting and 761 receiving CABG. The outcomes of interest were the major adverse vascular events (MACE) including death, Q-wave myocardial infarction, or stroke, and major adverse cardiac and cerebrovascular events (MACCE) including MACE or target vessel revascularization of ULMCA. The patients were classified into the low- (ⱕ22), intermediate- (⬎22 and ⬍33), and high- (ⱖ33) score groups. Results: The score was not normally distributed (p ⬍0.001), with a median of 30.0 and an interquartile range (IQR) of 19.0 to 40.5, which was higher in the CABG group (37.5; IQR 29.0 – 47.5) than the stenting group (23.0; IQR 14.0 –31.5; p ⬍0.001). Over 3 years, the high-score group had a higher incidence of MACE for the overall patient group (5.7%, 6.8%, and 12.1%, respectively; p ⬍0.001) and the stenting group (4.7%, 7.0%, and 12.8%, respectively; p ⫽ 0.002), but not for CABG group (10.5%, 6.6%, and 11.8%, respectively; p ⫽ 0.18). However, there was no significant association between the 3 SYNTAX classifications and the MACCE rate in overall patients (p ⫽ 0.52), stenting group (p ⫽ 0.062), or CABG group (p ⫽ 0.44). In Cox model, a significant interaction between treatment type and SYNTAX groups was not observed in the risk of MACE or MACCE. (Figure)

Complete 10-Year Outcomes after Stent Implantation versus Coronary Artery Bypass Grafting for Unprotected Left Main Coronary Artery Disease. Duk-Woo Park, Jong-Yong Lee, Won-Jang Kim, Soo-Jin Kang, Seung-Whan Lee, Young-Hak Kim, Cheol Whan Lee, Jae-Joong Kim, Seong-Wook Park, Seung-Jung Park. Asan Medical Center, Seoul, Republic of Korea. Background: The long-term (10-year) comparative results of patients with unprotected left main coronary artery (LMCA) disease who undergo coronary stenting or coronary artery bypass grafting (CABG) are unknown. Methods: Between January 1995 and April 1999, 350 patients with unprotected LMCA disease underwent stent implantation (n ⫽ 100) or CABG (n ⫽ 250). The primary safety endpoints were all-cause mortality and the composite of death, Q-wave myocardial infarction (MI), or stroke, and the primary efficacy endpoint was target vessel revascularization (TVR). Results: In a crude analysis, the 10-year rates of death (15.9% for percutaneous coronary intervention [PCI] vs 24.1% for CABG; p ⫽ 0.02) and the composite of death, Q-wave MI, or stroke (25.2% for PCI vs 32.1% for CABG; p ⫽ 0.04) were significantly lower in patients who received stenting than in those who underwent CABG. However, after adjustment for baseline risk factors, the overall risk of death (hazard ratio 0.68; 95% confidence interval [CI] 0.36 –1.30; p ⫽ 0.24) and the composite of death, Q-wave MI, or stroke (hazard ratio 0.90; 95% CI 0.54 –1.50; p ⫽ 0.69) were similar between the 2 groups. The rate of revascularization was significantly higher in the PCI than in the CABG group (hazard ratio 11.35, 95% CI 4.90 –26.31; p ⬍0.001). Conclusion: At 10-year follow-up of patients with unprotected LMCA disease, we found no significant difference in rates of death or of the composite point of death, Q-wave MI, or stroke between patients receiving stents and those undergoing CABG. However, stenting was associated with higher rates of TVR than was CABG.

AS-210 Impact of the Extent of Vascular Disease on Outcomes after Revascularization for Unprotected Left Main Coronary Artery Stenosis. Jung-Min Ahn, Young-Hak Kim, Won-Jang Kim, Duk-Woo Park, Jong-Young Lee, Sung-Cheol Yun, Soo-Jin Kang, Seung-Whan Lee, Cheol Whan Lee, Seong-Wook Park, Seung-Jung Park. Asan Medical Center, Seoul, Republic of Korea. Background: The differential outcome of unprotected left main coronary artery (ULMCA) revascularization according to vascular involvement remains uncertain. Methods: From the MAIN-COMPARE registry, 2240 patients with ULMCA stenosis who underwent either stenting or coronary artery bypass grafting (CABG) were stratified by number of diseased vessels. Results: Following adjustment with EuroSCORE, stents and CABG had similar risks of death and the composite of death, Q-wave myocardial infarction (QMI), or stroke in all subgroups regardless of the number of diseased vessels over 3 years. In patients with 3-vessel disease, however, overall stent use (hazard ratio [HR] 1.913; 95% confidence interval [CI] 1.391–2.631; p ⬍0.001) and the use of baremetal stents (HR 2.147; 95% CI 1.002– 4.600; p ⫽ 0.049) and drugeluting stents (HR 1.796; 95% CI 1.256 –2.570; p ⫽ 0.001) were

The American Journal of Cardiology姞 APRIL 28 –30 2010 ANGIOPLASTY SUMMIT ABSTRACTS/E-Poster 89B

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