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1
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Caliskan E, Misfeld M, Sandner S, Böning A, Aramendi J, Salzberg SP, Choi YH, Perrault LP, Tekin I, Cuerpo GP, Lopez-Menendez J, Weltert LP, Böhm J, Krane M, González-Santos JM, Tellez JC, Holubec T, Ferrari E, Emmert MY. Clinical event rate in patients with and without left main disease undergoing isolated CABG: results from the European DuraGraft registry. Eur J Cardiothorac Surg 2022; 62:6656349. [PMID: 35929787 DOI: 10.1093/ejcts/ezac403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 07/25/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Left main coronary artery disease (LMCAD) is considered an independent risk factor for clinical events after coronary artery bypass grafting (CABG). We have conducted a subgroup analysis of the multicentre European DuraGraft registry to investigate clinical event-rates at 1-year in patients with and without LMCAD undergoing isolated CABG in contemporary practice. METHODS Patients undergoing isolated CABG were selected. The primary end-point was the incidence of a major adverse cardiac event (MACE) defined as the composite of death, myocardial infarction (MI) or repeat revascularization (RR) at 1-year. The secondary end-point was major adverse cardiac and cerebrovascular events (MACCE) defined as MACE plus stroke. Propensity score matching (PSM) was performed to balance for differences in baseline characteristics. RESULTS LMCAD was present in 1,033 (41.2%) and absent in 1,477 (58.8%) patients. At 1-year, the MACE rate was higher for LMCAD patients (8.2% vs 5.1%, p = 0.002) driven by higher rates of death (5.4% vs 3.4%, p = 0.016), MI (3.0% vs 1.3%, p = 0.002) and numerically higher rates of RR (2.8% vs 1.8%, p = 0.13). The incidence of MACCE was 8.8% vs 6.6%, p = 0.043 with a stroke rate of 1.0% and 2.4%, p = 0.011, for LMCAD and non-LMCAD group, respectively. After PSM, the MACE rate was 8.0% vs 5.2%, p = 0.015. The incidence of death was 5.1% vs 3.7%, p = 0.10, MI 3.0% vs 1.4%, p = 0.020, and RR was 2.7% vs 1.6%, p = 0.090, for the LMCAD and non-LMCAD group, respectively. Less strokes occurred in LMCAD patients (1.0% vs 2.4%, p = 0.017). The MACCE rate was not different: 8.5% vs 6.7%, p = 0.12. CONCLUSIONS In this large registry, LMCAD was demonstrated to be an independent risk factor for MACE after isolated CABG. Conversely, the risk of stroke was lower in LMCAD patients. TRIAL REGISTRATION ClinicalTrials.gov NCT02922088.
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Affiliation(s)
- Etem Caliskan
- Charité Universitätsmedizin Berlin, Berlin, Germany.,German Heart Center Berlin, Berlin, Germany
| | - Martin Misfeld
- Leipzig Heart Center, Leipzig, Germany.,Royal Prince Alfred Hospital, Sydney, Australia.,Institute of Academic Surgery at RPA, Sydney, Australia.,The Baird Institute of Applied Heart and Lung Surgical Research, Sydney, Australia.,Medical School, University of Sydney, Australia
| | - Sigrid Sandner
- Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Andreas Böning
- Universitätsklinikum Gießen und Marburg GmbH, Gießen, Germany
| | | | | | - Yeong-Hoon Choi
- Kerckhoff Heart Center Bad Nauheim, Campus Kerckhoff Justus-Liebig University Giessen
| | | | - Ilker Tekin
- Manavgat Government Hospital, Manavgat, Turkey.,Bahçeşehir University Faculty of Medicine, İstanbul, Turkey
| | | | | | | | | | - Markus Krane
- German Heart Center Munich, Munich, Germany.,Yale University School of Medicine, New Haven, Connecticut, USA
| | | | | | - Tomas Holubec
- Goethe University Frankfurt and University Hospital Frankfurt, Frankfurt, Germany
| | - Enrico Ferrari
- Cardiocentro Ticino Institute, Lugano, Switzerland.,University of Zurich, School of Medicine, Zurich, Switzerland
| | - Maximilian Y Emmert
- Charité Universitätsmedizin Berlin, Berlin, Germany.,German Heart Center Berlin, Berlin, Germany
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Omar AS, Hanoura S, Shouman Y, Sivadasan PC, Sudarsanan S, Osman H, Pattath AR, Singh R, AlKhulaifi A. Intensive care outcome of left main stem disease surgery: A single center three years’ experience. World J Crit Care Med 2021; 10:12-21. [PMID: 33505869 PMCID: PMC7805253 DOI: 10.5492/wjccm.v10.i1.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 12/09/2020] [Accepted: 12/23/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Left main coronary artery (LMCA) supplies more than 80% of the left ventricle, and significant disease of this artery carries a high mortality unless intervened surgically. However, the influence of coronary artery bypass grafting (CABG) surgery on patients with LMCA disease on morbidity intensive care unit (ICU) outcomes needs to be explored. However, the impact of CABG surgery on the morbidity of the ICU population with LMCA disease is worth exploring.
AIM To determine whether LMCA disease is a definitive risk factor of prolonged ICU stay as a primary outcome and early morbidity within the ICU stay as secondary outcome.
METHODS Retrospective descriptive study with purposive sampling analyzing 399 patients who underwent isolated urgent or elective CABG. Patients were divided into 2 groups; those with LMCA disease as group 1 (75 patients) and those without LMCA disease as group 2 (324 patients). We correlated ICU outcome parameters including ICU length of stay, post-operative atrial fibrillation, acute kidney injury, re-exploration, perioperative myocardial infarction, post-operative bleeding in both groups.
RESULTS Patients with LMCA disease had a significantly higher prevalence of diabetes (43.3% vs 29%, P = 0.001). However, we did not find a statistically significant difference with regards to ICU stay, or other morbidity and mortality outcome measures.
CONCLUSION Post-operative performance of Patients with LMCA disease who underwent CABG were comparable to those without LMCA involvement. Diabetes was more prevalent in patients with LMCA disease. These findings may help in guiding decision making for future practice and stratifying the patients’ care.
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Affiliation(s)
- Amr S Omar
- Department of Cardiothoracic Surgery/Cardiac Anaesthesia and Intensive Care Unit, Hamad Medical Corporation, Doha 3050, DA, Qatar
- Department of Medicine, Weill Cornell Medical College in Qatar, Doha 3050, DA, Qatar
- Department of Critical Care Medicine, Beni Suef University, Beni Suef 62511, Egypt
| | - Samy Hanoura
- Department of Cardiothoracic Surgery, Hamad Medical Corporation, Doha 3050, DA, Qatar
- Department of Anesthesia, Alazhar University, Cairo 11651, Egypt
| | - Yasser Shouman
- Department of Cardiothoracic Surgery, Hamad Medical Corporation, Doha 3050, DA, Qatar
| | - Praveen C Sivadasan
- Department of Cardiothoracic Surgery/Intensive Care Unit Section, Hamad Medical Corporation, Doha 3050, DA, Qatar
| | - Suraj Sudarsanan
- Department of Cardiothoracic Surgery, Hamad Medical Corporation, Doha 3050, DA, Qatar
| | - Hany Osman
- Department of Cardiothoracic Surgery, Hamad Medical Corporation, Doha 3050, DA, Qatar
- Department of Anesthesia, Alazhar University, Cairo 11651, Egypt
| | - Abdul Rasheed Pattath
- Department of Cardiothoracic Surgery, Hamad Medical Corporation, Doha 3050, DA, Qatar
| | - Rajvir Singh
- Department of Medical Research, Hamad Medical Corporation, Doha 3050, DA, Qatar
| | - Abdulaziz AlKhulaifi
- Department of Cardiothoracic Surgery, Hamad Medical Corporation, Doha 3050, DA, Qatar
- Department of Cardiothoracic Surgery, Qatar University, Doha 3050, DA, Qatar
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Toyofuku M, Kimura T, Morimoto T, Hayashi Y, Ueda H, Kawai K, Nozaki Y, Hiramatsu S, Miura A, Yokoi Y, Toyoshima S, Nakashima H, Haze K, Tanaka M, Take S, Saito S, Isshiki T, Mitsudo K. Three-Year Outcomes After Sirolimus-Eluting Stent Implantation for Unprotected Left Main Coronary Artery Disease. Circulation 2009; 120:1866-74. [DOI: 10.1161/circulationaha.109.873349] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background—
Long-term outcomes after stenting of an unprotected left main coronary artery (ULMCA) with drug-eluting stents have not been addressed adequately despite the growing popularity of this procedure.
Methods and Results—
j-Cypher is a multicenter prospective registry of consecutive patients undergoing sirolimus-eluting stent implantation in Japan. Among 12 824 patients enrolled in the j-Cypher registry, the unadjusted mortality rate at 3 years was significantly higher in patients with ULMCA stenting (n=582) than in patients without ULMCA stenting (n=12 242; 14.6% versus 9.2%, respectively;
P
<0.0001); however, there was no significant difference between the 2 groups in the adjusted risk of death (hazard ratio 1.23, 95% confidence interval 0.95 to 1.60,
P
=0.12). Among 476 patients whose ULMCA lesions were treated exclusively with a sirolimus-eluting stent, patients with ostial/shaft lesions (n=96) compared with those with bifurcation lesions (n=380) had a significantly lower rate of target-lesion revascularization for the ULMCA lesions (3.6% versus 17.1%,
P
=0.005), with similar cardiac death rates at 3 years (9.8% versus 7.6%,
P
=0.41). Among patients with bifurcation lesions, patients with stenting of both the main and side branches (n=119) had significantly higher rates of cardiac death (12.2% versus 5.5%;
P
=0.02) and target-lesion revascularization (30.9% versus 11.1%;
P
<0.0001) than those with main-branch stenting alone (n=261).
Conclusions—
The higher unadjusted mortality rate of patients undergoing ULMCA stenting with a sirolimus-eluting stent did not appear to be related to ULMCA treatment itself but rather to the patients’ high-risk profile. Although long-term outcomes in patients with ostial/shaft ULMCA lesions were favorable, outcomes in patients with bifurcation lesions treated with stenting of both the main and side branches appeared unacceptable.
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Affiliation(s)
- Mamoru Toyofuku
- From Tsuchiya General Hospital (M. Toyofuku, Y.H., H.U.), Hiroshima, Japan; Department of Cardiovascular of Medicine (T.K.) and Center for Medical Education and Clinical Epidemiology Unit (T.M.), Graduate School of Medicine, Kyoto University, Kyoto, Japan; Chikamori Hospital (K.K.), Kochi, Japan; Hokko Memorial Hospital (Y.N.), Sapporo, Japan; Ehime Prefectural Central Hospital (S.H.), Matsuyama, Japan; Japanese Red Cross Society Wakayama Medical Center (A.M.), Wakayama, Japan; Kishiwada Tokushukai
| | - Takeshi Kimura
- From Tsuchiya General Hospital (M. Toyofuku, Y.H., H.U.), Hiroshima, Japan; Department of Cardiovascular of Medicine (T.K.) and Center for Medical Education and Clinical Epidemiology Unit (T.M.), Graduate School of Medicine, Kyoto University, Kyoto, Japan; Chikamori Hospital (K.K.), Kochi, Japan; Hokko Memorial Hospital (Y.N.), Sapporo, Japan; Ehime Prefectural Central Hospital (S.H.), Matsuyama, Japan; Japanese Red Cross Society Wakayama Medical Center (A.M.), Wakayama, Japan; Kishiwada Tokushukai
| | - Takeshi Morimoto
- From Tsuchiya General Hospital (M. Toyofuku, Y.H., H.U.), Hiroshima, Japan; Department of Cardiovascular of Medicine (T.K.) and Center for Medical Education and Clinical Epidemiology Unit (T.M.), Graduate School of Medicine, Kyoto University, Kyoto, Japan; Chikamori Hospital (K.K.), Kochi, Japan; Hokko Memorial Hospital (Y.N.), Sapporo, Japan; Ehime Prefectural Central Hospital (S.H.), Matsuyama, Japan; Japanese Red Cross Society Wakayama Medical Center (A.M.), Wakayama, Japan; Kishiwada Tokushukai
| | - Yasuhiko Hayashi
- From Tsuchiya General Hospital (M. Toyofuku, Y.H., H.U.), Hiroshima, Japan; Department of Cardiovascular of Medicine (T.K.) and Center for Medical Education and Clinical Epidemiology Unit (T.M.), Graduate School of Medicine, Kyoto University, Kyoto, Japan; Chikamori Hospital (K.K.), Kochi, Japan; Hokko Memorial Hospital (Y.N.), Sapporo, Japan; Ehime Prefectural Central Hospital (S.H.), Matsuyama, Japan; Japanese Red Cross Society Wakayama Medical Center (A.M.), Wakayama, Japan; Kishiwada Tokushukai
| | - Hiroaki Ueda
- From Tsuchiya General Hospital (M. Toyofuku, Y.H., H.U.), Hiroshima, Japan; Department of Cardiovascular of Medicine (T.K.) and Center for Medical Education and Clinical Epidemiology Unit (T.M.), Graduate School of Medicine, Kyoto University, Kyoto, Japan; Chikamori Hospital (K.K.), Kochi, Japan; Hokko Memorial Hospital (Y.N.), Sapporo, Japan; Ehime Prefectural Central Hospital (S.H.), Matsuyama, Japan; Japanese Red Cross Society Wakayama Medical Center (A.M.), Wakayama, Japan; Kishiwada Tokushukai
| | - Kazuya Kawai
- From Tsuchiya General Hospital (M. Toyofuku, Y.H., H.U.), Hiroshima, Japan; Department of Cardiovascular of Medicine (T.K.) and Center for Medical Education and Clinical Epidemiology Unit (T.M.), Graduate School of Medicine, Kyoto University, Kyoto, Japan; Chikamori Hospital (K.K.), Kochi, Japan; Hokko Memorial Hospital (Y.N.), Sapporo, Japan; Ehime Prefectural Central Hospital (S.H.), Matsuyama, Japan; Japanese Red Cross Society Wakayama Medical Center (A.M.), Wakayama, Japan; Kishiwada Tokushukai
| | - Yoichi Nozaki
- From Tsuchiya General Hospital (M. Toyofuku, Y.H., H.U.), Hiroshima, Japan; Department of Cardiovascular of Medicine (T.K.) and Center for Medical Education and Clinical Epidemiology Unit (T.M.), Graduate School of Medicine, Kyoto University, Kyoto, Japan; Chikamori Hospital (K.K.), Kochi, Japan; Hokko Memorial Hospital (Y.N.), Sapporo, Japan; Ehime Prefectural Central Hospital (S.H.), Matsuyama, Japan; Japanese Red Cross Society Wakayama Medical Center (A.M.), Wakayama, Japan; Kishiwada Tokushukai
| | - Shinichi Hiramatsu
- From Tsuchiya General Hospital (M. Toyofuku, Y.H., H.U.), Hiroshima, Japan; Department of Cardiovascular of Medicine (T.K.) and Center for Medical Education and Clinical Epidemiology Unit (T.M.), Graduate School of Medicine, Kyoto University, Kyoto, Japan; Chikamori Hospital (K.K.), Kochi, Japan; Hokko Memorial Hospital (Y.N.), Sapporo, Japan; Ehime Prefectural Central Hospital (S.H.), Matsuyama, Japan; Japanese Red Cross Society Wakayama Medical Center (A.M.), Wakayama, Japan; Kishiwada Tokushukai
| | - Akira Miura
- From Tsuchiya General Hospital (M. Toyofuku, Y.H., H.U.), Hiroshima, Japan; Department of Cardiovascular of Medicine (T.K.) and Center for Medical Education and Clinical Epidemiology Unit (T.M.), Graduate School of Medicine, Kyoto University, Kyoto, Japan; Chikamori Hospital (K.K.), Kochi, Japan; Hokko Memorial Hospital (Y.N.), Sapporo, Japan; Ehime Prefectural Central Hospital (S.H.), Matsuyama, Japan; Japanese Red Cross Society Wakayama Medical Center (A.M.), Wakayama, Japan; Kishiwada Tokushukai
| | - Yoshiaki Yokoi
- From Tsuchiya General Hospital (M. Toyofuku, Y.H., H.U.), Hiroshima, Japan; Department of Cardiovascular of Medicine (T.K.) and Center for Medical Education and Clinical Epidemiology Unit (T.M.), Graduate School of Medicine, Kyoto University, Kyoto, Japan; Chikamori Hospital (K.K.), Kochi, Japan; Hokko Memorial Hospital (Y.N.), Sapporo, Japan; Ehime Prefectural Central Hospital (S.H.), Matsuyama, Japan; Japanese Red Cross Society Wakayama Medical Center (A.M.), Wakayama, Japan; Kishiwada Tokushukai
| | - Shinichiro Toyoshima
- From Tsuchiya General Hospital (M. Toyofuku, Y.H., H.U.), Hiroshima, Japan; Department of Cardiovascular of Medicine (T.K.) and Center for Medical Education and Clinical Epidemiology Unit (T.M.), Graduate School of Medicine, Kyoto University, Kyoto, Japan; Chikamori Hospital (K.K.), Kochi, Japan; Hokko Memorial Hospital (Y.N.), Sapporo, Japan; Ehime Prefectural Central Hospital (S.H.), Matsuyama, Japan; Japanese Red Cross Society Wakayama Medical Center (A.M.), Wakayama, Japan; Kishiwada Tokushukai
| | - Hitoshi Nakashima
- From Tsuchiya General Hospital (M. Toyofuku, Y.H., H.U.), Hiroshima, Japan; Department of Cardiovascular of Medicine (T.K.) and Center for Medical Education and Clinical Epidemiology Unit (T.M.), Graduate School of Medicine, Kyoto University, Kyoto, Japan; Chikamori Hospital (K.K.), Kochi, Japan; Hokko Memorial Hospital (Y.N.), Sapporo, Japan; Ehime Prefectural Central Hospital (S.H.), Matsuyama, Japan; Japanese Red Cross Society Wakayama Medical Center (A.M.), Wakayama, Japan; Kishiwada Tokushukai
| | - Kazuo Haze
- From Tsuchiya General Hospital (M. Toyofuku, Y.H., H.U.), Hiroshima, Japan; Department of Cardiovascular of Medicine (T.K.) and Center for Medical Education and Clinical Epidemiology Unit (T.M.), Graduate School of Medicine, Kyoto University, Kyoto, Japan; Chikamori Hospital (K.K.), Kochi, Japan; Hokko Memorial Hospital (Y.N.), Sapporo, Japan; Ehime Prefectural Central Hospital (S.H.), Matsuyama, Japan; Japanese Red Cross Society Wakayama Medical Center (A.M.), Wakayama, Japan; Kishiwada Tokushukai
| | - Masaru Tanaka
- From Tsuchiya General Hospital (M. Toyofuku, Y.H., H.U.), Hiroshima, Japan; Department of Cardiovascular of Medicine (T.K.) and Center for Medical Education and Clinical Epidemiology Unit (T.M.), Graduate School of Medicine, Kyoto University, Kyoto, Japan; Chikamori Hospital (K.K.), Kochi, Japan; Hokko Memorial Hospital (Y.N.), Sapporo, Japan; Ehime Prefectural Central Hospital (S.H.), Matsuyama, Japan; Japanese Red Cross Society Wakayama Medical Center (A.M.), Wakayama, Japan; Kishiwada Tokushukai
| | - Shunsuke Take
- From Tsuchiya General Hospital (M. Toyofuku, Y.H., H.U.), Hiroshima, Japan; Department of Cardiovascular of Medicine (T.K.) and Center for Medical Education and Clinical Epidemiology Unit (T.M.), Graduate School of Medicine, Kyoto University, Kyoto, Japan; Chikamori Hospital (K.K.), Kochi, Japan; Hokko Memorial Hospital (Y.N.), Sapporo, Japan; Ehime Prefectural Central Hospital (S.H.), Matsuyama, Japan; Japanese Red Cross Society Wakayama Medical Center (A.M.), Wakayama, Japan; Kishiwada Tokushukai
| | - Shigeru Saito
- From Tsuchiya General Hospital (M. Toyofuku, Y.H., H.U.), Hiroshima, Japan; Department of Cardiovascular of Medicine (T.K.) and Center for Medical Education and Clinical Epidemiology Unit (T.M.), Graduate School of Medicine, Kyoto University, Kyoto, Japan; Chikamori Hospital (K.K.), Kochi, Japan; Hokko Memorial Hospital (Y.N.), Sapporo, Japan; Ehime Prefectural Central Hospital (S.H.), Matsuyama, Japan; Japanese Red Cross Society Wakayama Medical Center (A.M.), Wakayama, Japan; Kishiwada Tokushukai
| | - Takaaki Isshiki
- From Tsuchiya General Hospital (M. Toyofuku, Y.H., H.U.), Hiroshima, Japan; Department of Cardiovascular of Medicine (T.K.) and Center for Medical Education and Clinical Epidemiology Unit (T.M.), Graduate School of Medicine, Kyoto University, Kyoto, Japan; Chikamori Hospital (K.K.), Kochi, Japan; Hokko Memorial Hospital (Y.N.), Sapporo, Japan; Ehime Prefectural Central Hospital (S.H.), Matsuyama, Japan; Japanese Red Cross Society Wakayama Medical Center (A.M.), Wakayama, Japan; Kishiwada Tokushukai
| | - Kazuaki Mitsudo
- From Tsuchiya General Hospital (M. Toyofuku, Y.H., H.U.), Hiroshima, Japan; Department of Cardiovascular of Medicine (T.K.) and Center for Medical Education and Clinical Epidemiology Unit (T.M.), Graduate School of Medicine, Kyoto University, Kyoto, Japan; Chikamori Hospital (K.K.), Kochi, Japan; Hokko Memorial Hospital (Y.N.), Sapporo, Japan; Ehime Prefectural Central Hospital (S.H.), Matsuyama, Japan; Japanese Red Cross Society Wakayama Medical Center (A.M.), Wakayama, Japan; Kishiwada Tokushukai
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