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01-05-2011 | Original Paper

Clinical outcome and quality of life after interventional treatment of left main disease with drug-eluting-stents in comparison to CABG in elderly and younger patients

Authors: H. Rittger, J. Rieber, K. Kögler, A. Sinha, M. Schmidt, O.-A. Breithardt, P. Biggar, F. Einsle, A. Diegeler, J. Brachmann

Published in: Clinical Research in Cardiology | Issue 5/2011

Abstract

Introduction

The aim of this study was to prospectively assess the clinical outcome and quality of life of elderly patients who underwent either coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) with drug-eluting stents (DES) for treatment of significant left main disease (LMD) compared to a younger patient population.

Methods

Consecutive patients, admitted into our institution between 04/2004 and 12/2007 with LMD and a life expectancy of >1 year were prospectively included and stratified in two groups (either CABG or left main stenting [LMS] with DES) based on the patients’ age at inclusion (> or ≤75 years). Rates of death, myocardial infarction (MI), stroke, and target lesion revascularization (TLR) were evaluated over a 12 month follow-up. Six months after the initial procedure, additionally, quality of life was assessed using the SF-36 questionnaire.

Results

A total of 300 patients was included; 56 of the 95 PCI patients (59%) were ≤75 years and 39 (44%) >75 years, whereas 155 of 205 patients in the CABG group were ≤75 years (76%), and 50 patients (24%) were >75 years. Mean follow-up was 312 ± 226 days in the PCI and 377 ± 286 in the CABG group. Rates of death and MI were not significantly different between the four groups at the end of follow-up. There was no difference in quality of life after 6 months.

Conclusion

In this prospective trial, PCI of LM with DES in elderly patients was feasible with a short- and intermediate term outcome comparable to CABG procedure and to a younger patient cohort.

Yusuf S, Zucker D, Peduzzi P, Fisher LD, Takaro T, Kennedy JW, Davis K, Killip T, Passamani E, Norris R et al (1994) Effect of coronary artery bypass graft surgery on survival: overview of 10-year results from randomised trials by the Coronary Artery Bypass Graft Surgery Trialists Collaboration. Lancet 344:563–570PubMedCrossRef

Silvestri M, Barragan P, Sainsous J, Bayet G, Simeoni JB, Roquebert PO, Macaluso G, Bouvier JL, Comet B (2000) Unprotected left main coronary artery stenting: immediate and mid-term outcomes of 140 elective procedures. J Am Coll Cardiol 35:1543–1550PubMedCrossRef

Black A, Cortina R, Bossi I, Choussat R, Fajadet J, Marco J (2001) Unprotected left main coronary artery stenting: correlates of midterm survival and impact of patient selection. J Am Coll Cardiol 37:832–838PubMedCrossRef

European Coronary Surgery Group (1982) Long-term results of prospective randomized study of coronary artery bypass surgery in stable angina pectoris. Lancet 66:14–22

Takaro T, Peduzzi P, Detre KM, Hultgren HN, Murphy ML, van der Bel-Kahn J, Thomsen J, Meadows WR (1982) Survival in subgroups of patients with left main coronary artery disease. Veterans administration cooperative study group of surgery for coronrary arterial occlusive disease. Circulation 66:14–22PubMed

Caracciolo EA, Davis KB, Sopko G, Kaiser GC, Corley SD, Schaff H, Taylor HA, Chaitman BR (1995) Comparison of surgical and medical group survival in patients with left main coronary artery disease. Long-term CASS experience. Circulation 91:2325–2334PubMed

Serruys PW, Morice MC, Kappetein AP, Colombo A, Holmes DR, Mack MJ, Stahle E, Feldmann TE, van den Brand M, Bass EJ, Van Dyck N, Leadley K, Dawkins KD, Mohr FW (2009) SYNTAX Investigators. Percutaneous Coronary Intervention versus Coronary-Artery Bypass Grafting for Severe Coronary Artery Disease. N Engl J Med 360:961–972PubMedCrossRef

Valgimigli M, Malagutti P, Rodriguez-Granillo GA, Garcia-Garcia HM, Polad J, Tsuchida K, Regar E, Van der Giessen WJ, de Jaegere P, De Feyter P, Serruys PW (2006) Distal left main coronary disease is a major predictor of outcome in patients undergoing percutaneous intervention in the drug-eluting stent era: an integrated clinical and angiographic analysis based on the Rapamycin-Eluting Stent evaltuated at Rotterdam Cardiology Hospital (RESEARCH) and Taxus-Stent evalutated at Rotterdam Cardiology Hospital (T-Search) registries. J Am Coll Cardiol 47(8):1530–1537PubMedCrossRef

de Lezo JS, Medina A, Pan M, Delgado A, Segura J, Pavlovic D, Melián F, Romero M, Burgos, Hernández E, Urena I, Herrador J (2004) Rapamycin-eluting stents for the treatment of unprotected left main coronary disease. Am Heart J 148:481–485PubMedCrossRef

10.

Park SJ, Kim YH, Lee BK, Lee SW, Lee CW, Hong MK, Kim JJ, Mintz GS, Park SW (2005) Sirolimus-eluting stent implantation for unprotected left main coronary artery stenosis: comparison with bare metal stent implantation. J Am Coll Cardiol 45:351–356PubMedCrossRef

11.

Valgimigli M, van Mieghem CA, Ong AT, Aoki J, Granillo GA, McFadden EP, Kappetein AP, de Feyter PJ, Smits PC, Regar E, Van der Giessen WJ, Sianos G, de Jaegere P, Van Domburg RT, Serruys PW (2005) Short- and long-term clinical outcome after drug-eluting stent implantation for the percutaneous treatment of left main coronary artery disease; insights from the Rapamycin-Eluting and Taxus Stent evaluated at Rotterdam Cardiology Hospital registries (RESEARCH and T-SEARCH). Circulation 111:1383–1389PubMedCrossRef

12.

Price MJ, Cristea E, Sawhney N, Kao JA, Moses JW, Leon MB, Costa RA, Lansky AJ, Teirstein PS (2006) Serial angiographic follow-up of sirolimus-eluting stents for unprotected left main coronary artery revascularization. J Am Coll Cardiol 47:871–877PubMedCrossRef

13.

Kastrati A, Mehilli J, Pache J, Kaiser C, ValgimigliM Kelbaek H, Menichelli M, Suttorp MJ, Baumgart D, Seyfarth M, Pfisterer ME, Schömig A (2007) Analysis of 14 trials comparing sirolimus-eluting stents with bare-metal stents. N Engl J Med 356:1030–1039PubMedCrossRef

14.

Stone GW, Moses JW, Ellis SG, Schofer J, Dawkins KD, Morice MC, Colombo A, Schampaert E, Grube E, Kirtane AJ, Cutlip DE, Fahy M, Pocock SJ, Mehran R, Leon MB (2007) Safety and efficacy of sirolimus- and paclitaxel-eluting coronary stents. N Engl J Med 356:1030–1039CrossRef

15.

Lee MS, Kapoor N, Jamal F, Czer L, Aragon J, Forrester J, Kar S, Dohad S, Kass R, Eigler N, Trento A, Shah PK, Makkar RR (2006) Comparison of coronary artery bypass surgery with percutaneous coronary intervention with drug eluting stents for unprotected left main coronary artery disease. J Am Coll Cardiol 47:864–870PubMedCrossRef

16.

Kappetein AP, Dawkins KD, Mohr FW, Morice MC, Mack MJ, Russell ME, Pomar J, Serruys PW (2006) Current percutaneous coronary intervention and coronary bypass grafting practices for three-vessel and left main coronary artery disease. Insights from the SYNTAX run-in phase. Eur J Cardiothorac Surg 29:486–491PubMedCrossRef

17.

Chieffo A, Morici N, Maisano F, Bonizzoni E, Cosgrave J, Montorfano M, Airoldi F, Carlino M, Michev I, Melzi G, Sangiorgi G, Alfieri O, Colombo A (2006) Percutaneous treatment with drug eluting stent implantation versus bypass surgery for unprotected left main stenosis. Circulation 113:2542–2547PubMedCrossRef

18.

Palmerini T, Marzocchi A, Marrozzini C, Ortolani P, Saia F, Savini C, Bacci-Reggiani L, Gianstefani S, Virzí S, Manara F, Kiros Weldeab M, Marinelli G, Bartolomeo R, Branzi A (2006) Comparison between coronary angioplasty and coronary artery bypass surgery for the treatment of unprotected left main coronary artery stenosis (the Bologna Registry). Am J Cardiol 98:56–59

19.

Buszman PE, Kiesz SR, Bochenek A, Peszek-Przybyla E, Szkrobka I, Debinski M, Bialkowska B, Dudek D, Gruszka A, Zurakowski A, Milewski K, Wilczynski M, Rzeszutko L, Buszman P, Szymszal J, Martin JL, Tendera M (2008) Acute and late outcomes of unprotected left main stenting in comparison with surgical revascularization. JACC 51:538–545PubMed

20.

Seung KB, Park DW, Kim YH, Lee SW, Lee CW, Hong MK, Park SW, Yun SC, Gwon HC, Jeong MH, Jang Y, Kim HS, Kim PJ, Seong IW, Park HS, Ahn T, Chae IH, Tahk SJ, Chung WS, Park SJ (2008) Stents versus coronary-artery-bypass grafting for left main coronary artery disease. New Engl J Med 358:1781–1792PubMedCrossRef

21.

Cutlip DE, Windecker S, Mehran R, Boam A, Cohen DJ, van Es GA, Steg PG, Morel MA, Mauri L, Vranckx P, McFadden E, Lansky A, Hamon M, Krucoff MW, Serruys PW (2007) Academic Research Consortium. Clinical end points in coronary stent trials: a case for standardized definitions. Circulation 115:2344–2351PubMedCrossRef

22.

The MOS 36-item Short-Form Health Survey (SF-36) (1994) III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. In: McHorney CA, Ware JE Jr, Lu JF, Sherbourne CD. Med Care 32:40–66

23.

Rodés-Cabau J, Deblois J, Bertrand OF, Mohammadi S, Courtis J, Larose E, Dagenais F, Déry JP, Mathieu P, Rousseau M, Barbeau G, Baillot R, Gleeton O, Perron J, Nguyen CM, Roy L, Doyle D, De Larochelliére R, Bogaty P, Voisine P (2008) Nonrandomized comparison of coronary artery bypass surgery and percutaneous coronary intervention for the treatment of unprotected left main coronary artery disease in octogenarians. Circulation 118:2374–2381PubMedCrossRef

24.

Ragosta M, Dee S, Sarembock IJ, Lipson LC, Gimple LW, Powers ER (2006) Prevalence of unfavourable angiographic characteristics for percutaneous intervention in patients with unprotected left main coronary artery disease. Catheter Cardiovasc Interv 68:357–362PubMedCrossRef

25.

Kim YH, Park SW, Hong MK, Park DW, Park KM, Lee BK, Song JM, Han KH, Lee CW, Kang DH, Song JK, Kim JJ, Park SJ (2006) Comparison of simple and complex stenting techniques in the treatment of unprotected left main coronary artery bifurcation stenosis. Am J Cardiol 97:1597–1601PubMedCrossRef

Title: Clinical outcome and quality of life after interventional treatment of left main disease with drug-eluting-stents in comparison to CABG in elderly and younger patients
Authors: H. Rittger
J. Rieber
K. Kögler
A. Sinha
M. Schmidt
O.-A. Breithardt
P. Biggar
F. Einsle
A. Diegeler
J. Brachmann
Publication date: 01-05-2011
Publisher: Springer-Verlag
Published in: Clinical Research in Cardiology / Issue 5/2011
Print ISSN: 1861-0684
Electronic ISSN: 1861-0692
DOI: https://doi.org/10.1007/s00392-010-0262-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Clinical outcome and quality of life after interventional treatment of left main disease with drug-eluting-stents in comparison to CABG in elderly and younger patients

Abstract

Introduction

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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