Circulation journal : official journal of the Japanese Circulation Society · 2010
Mid-term results and costs of coronary artery bypass vs drug-eluting stents for unprotected left main coronary artery disease.
Сравнительное исследованиеСтатьяНазвание и аннотация: Перевод пока не подготовлен
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Shimizu Tsuyoshi, Ohno Takayuki, Ando Jiro, Fujita Hideo, Nagai Ryozo, Motomura Noboru, Ono Minoru, Kyo Shunei, Takamoto Shinichi
Аннотация
BACKGROUND: The optimal revascularization strategy for unprotected left main coronary artery (ULMCA) disease in the era of drug-eluting stents (DES) has become more controversial between coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI).
METHODS AND RESULTS: Since April 2004, 89 patients underwent CABG, including 82 (92.1%) off-pump procedures and 63 patients underwent PCI with DES for ULMCA disease. Major adverse cardiac and cerebrovascular events (MACCE: death, acute myocardial infarction, stroke and repeat revascularization) and hospitalization costs were compared. Patients in the CABG group were likely to have multivessel disease and higher euroSCORE. The mean follow-up was 2.2+/-1.1 years in the CABG group and 1.6+/-0.8 years in the DES group (P<0.001). The overall survival rate did not differ (P=0.288) between the groups (CABG: 93.4% and DES: 91.9% at 2 years). The MACCE-free survival rate was better (P=0.033) in the CABG group (CABG: 82.2% and DES: 62.6% at 2 years). Total hospitalization costs were lower (P=0.013) in the CABG group (median: 3,225 thousand yen) than in the DES group (median: 4,192 thousand yen).
CONCLUSIONS: CABG might be associated with cost-effectiveness and could be still the first revascularization strategy for ULMCA disease.
METHODS AND RESULTS: Since April 2004, 89 patients underwent CABG, including 82 (92.1%) off-pump procedures and 63 patients underwent PCI with DES for ULMCA disease. Major adverse cardiac and cerebrovascular events (MACCE: death, acute myocardial infarction, stroke and repeat revascularization) and hospitalization costs were compared. Patients in the CABG group were likely to have multivessel disease and higher euroSCORE. The mean follow-up was 2.2+/-1.1 years in the CABG group and 1.6+/-0.8 years in the DES group (P<0.001). The overall survival rate did not differ (P=0.288) between the groups (CABG: 93.4% and DES: 91.9% at 2 years). The MACCE-free survival rate was better (P=0.033) in the CABG group (CABG: 82.2% and DES: 62.6% at 2 years). Total hospitalization costs were lower (P=0.013) in the CABG group (median: 3,225 thousand yen) than in the DES group (median: 4,192 thousand yen).
CONCLUSIONS: CABG might be associated with cost-effectiveness and could be still the first revascularization strategy for ULMCA disease.
Предметные рубрики MeSH
AgedAngioplasty, Balloon, CoronaryCoronary Artery Bypass, Off-PumpCoronary Artery DiseaseCoronary VesselsDrug-Eluting StentsFemaleFollow-Up StudiesHospital CostsHumansJapanKaplan-Meier EstimateMaleMiddle AgedMyocardial InfarctionOutcome and Process Assessment, Health CareProspective StudiesQuality-Adjusted Life YearsRisk FactorsSeverity of Illness IndexStroke