Unprotected Left Main Revascularization in the Setting of Non-coronary Atherosclerosis: Gulf Left Main Registry.
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Daoulah Amin, Abozenah Mohammed, Alshehri Mohammed, Hersi Ahmad S, Yousif Nooraldaem, Garni Turki Al, Abuelatta Reda, Almahmeed Wael, Alasmari Abdulaziz, Alzahrani Badr, Ghani Mohamed Ajaz, Amin Haitham, Hashmani Shahrukh, Hiremath Niranjan, Alharbi Ahmad W, Kazim Hameedullah M, Refaat Wael, Selim Ehab, Dahdouh Ziad, Aithal Jairam, Ibrahim Ahmed M, Elganady Abdelmaksoud, Qutub Mohammed A, Alama Mohamed N, Abohasan Abdulwali, Hassan Taher, Balghith Mohammed, Hussien Adnan Fathey, Abdulhabeeb Ibrahim Am, Ahmad Osama, Ramadan Mohamed, Alqahtani Abdulrahman H, Ahmed Fatima Ali, Qenawi Wael, Shawky Ahmed, Ghonim Ahmed A, Jamjoom Ahmed, El-Sayed Osama, Elmahrouk Ahmed, Elfarnawany Amr, Elsheikh-Mohamed Nezar Essam, Abumelha Bader K, Shawky Abeer M, Arafat Amr A, Naser Maryam Jameel, Elmahrouk Youssef, Alhamid Sameer, Lotfi Amir
Аннотация
Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in revascularization of left main coronary artery (LMCA) disease has been evaluated in previous studies. However, there has been minimal study of the relationship between co-existing non-coronary atherosclerosis (NCA) and LMCA disease revascularization. We aim to examine this relationship. The Gulf-LM study is a retrospective analysis of unprotected LMCA revascularization cases undergoing PCI with second generation drug-eluting stent vs CABG across 14 centers within 3 Gulf countries between January 2015 and December 2019. A total of 2138 patients were included, 381 with coexisting NCA and 1757 without. Outcomes examined included major adverse cardiovascular and cerebrovascular events (MACCE), cardiac and non-cardiac death, and all bleeding. In patients with NCA, preexisting myocardial infarction and congestive heart failure were more common, with PCI being the most common revascularization strategy. A statistically significant reduction in in-hospital MACCE and all bleeding was noted in patients with NCA undergoing PCI as compared to CABG. At a median follow-up of 15 months, MACCE and major bleeding outcomes continued to favor the PCI group, though no such difference was identified between revascularization strategies in patients without NCA.In this multicenter retrospective study of patients with and without NCA who require revascularization (PCI and CABG) for unprotected LMCA disease, PCI demonstrated a better clinical outcome in MACCE both in-hospital and during the short-term follow-up in patients with NCA. However, no such difference was observed in patients without NCA.