Long-term follow-up of a randomized, controlled clinical trial of three therapeutic strategies for multivessel stable coronary artery disease in women.

Coronary artery disease is the leading cause of death in women. The proposed treatments for women are similar to those for men. However, in women with multivessel stable coronary artery disease and normal left ventricular function, the best treatment is unknown. A post hoc analysis of the MASS II study with 10 years of follow-up, mean (standard deviation) 6.8 (3.7) years, enrolled between May 1995 and May 2000, evaluated 188 women with chronic stable multivessel coronary artery disease who underwent medical treatment, percutaneous coronary intervention or coronary artery bypass graft surgery. Primary end-points were incidence of total mortality, Q-wave myocardial infarction, or refractory angina. Data were analysed according to the intention-to-treat principle. Women treated with percutaneous coronary intervention and medical treatment had more primary events than those treated with coronary artery bypass graft surgery, respectively, of 34, 44 and 22% (P = 0.003). Survival rates at 10 years were 72% for coronary artery bypass graft surgery, 72% for percutaneous coronary intervention and 56% for medical treatment (P = 0.156). For the composite end-point, Cox regression analysis adjusted for age, diabetes, hypertension, treatment allocation, prior myocardial infarction, smoking, number of vessels affected and total cholesterol, had a higher incidence of primary events with medical treatment than with coronary artery bypass graft surgery [hazard ratio (HR) = 2.38 (95% confidence interval (CI): 1.40-4.05); P = 0.001], a lower incidence with percutaneous coronary intervention than with medical treatment [HR = 0.60 (95% CI: 0.38-0.95); P = 0.031] but no differences between coronary artery bypass graft surgery and percutaneous coronary intervention. Regarding death, a protective effect was observed with percutaneous coronary intervention compared with medical treatment [HR = 0.44 (95% CI: 0.21-0.90); P = 0.025]. Percutaneous coronary intervention and coronary artery bypass graft surgery compared with medical treatment had better results after 10 years of follow-up.

Mansur Ade P ，Hueb WA ，Takada JY ，Avakian SD ，Soares PR ，Garzilo CL ，Kalil Filho R ，Ramires JA ... -  《-》

Ten-year outcomes of patients randomized to surgery, angioplasty, or medical treatment for stable multivessel coronary disease: effect of age in the Medicine, Angioplasty, or Surgery Study II trial.

With progressive aging, coronary artery disease has been diagnosed at more advanced ages. Although patients aged 65 years or more have been referred to surgical or percutaneous coronary interventions, the best option for coronary artery disease treatment remains uncertain. The current study compared the 3 treatment options for coronary artery disease in patients aged 65 years or more and analyzed the impact of age in treatment options. Patients were separated according to age: 65 years or more (n = 200) and less than 65 years (n = 411). All patients were followed for 10 years. The rates of overall mortality, acute myocardial infarction, and new revascularizations were analyzed. Of 200 patients aged 65 years or more, 68 were randomized to medical therapy, 68 were randomized to percutaneous coronary intervention, and 64 were randomized to coronary artery bypass grafting. At 10 years, overall survival was 63% (medical therapy), 69% (percutaneous coronary intervention), and 66% (coronary artery bypass grafting) (P = .93). The survival free of combined events was 43% (medical therapy), 38% (percutaneous coronary intervention ), and 66% (coronary artery bypass grafting) (P = .007). The survival free of myocardial infarction was 82% (medical therapy), 77% (percutaneous coronary intervention), and 90% (coronary artery bypass grafting) (P = .17), and survival free of new revascularizations was 59% (medical therapy), 58% (percutaneous coronary intervention ), and 91% (coronary artery bypass grafting) (P = .0003). When the 2 age groups were compared, survival free of myocardial infarction for patients treated by percutaneous coronary intervention was 77% (older patients) and 92% (younger patients) (P = .004). In this analysis, treatment options for patients aged 65 years or more who have coronary artery disease yield similar overall survival. However, coronary artery bypass grafting was associated with fewer coronary events, and percutaneous coronary intervention was associated with a higher incidence of myocardial infarction.

Rezende PC ，Hueb W ，Garzillo CL ，Lima EG ，Hueb AC ，Ramires JA ，Kalil Filho R ... -  《-》

Long-term clinical outcomes after percutaneous coronary intervention versus coronary artery bypass grafting for ostial/midshaft lesions in unprotected left main coronary artery from the DELTA registry: a multicenter registry evaluating percutaneous corona

The aim of this study was to report the long-term clinical outcomes after percutaneous coronary intervention (PCI) with drug-eluting stents (DES) versus coronary artery bypass grafting (CABG) for ostial/midshaft lesions in an unprotected left main coronary artery (ULMCA). Data regarding outcomes in these patients are limited. Of a total of 2,775 patients enrolled in the DELTA multinational registry, 856 patients with isolated ostial/midshaft lesions in an ULMCA treated by PCI with DES (n = 482) or CABG (n = 374) were analyzed. At a median follow-up period of 1,293 days, there were no significant differences in the propensity score-adjusted analyses for the composite endpoint of all-cause death, myocardial infarction (MI), and cerebrovascular accident (hazard ratio [HR]: 1.21, 95% confidence interval [CI]: 0.79 to 1.86; p = 0.372), all-cause death (HR: 1.35, 95% CI: 0.80 to 2.27; p = 0.255), the composite endpoint of all-cause death and MI (HR: 1.33, 95% CI: 0.83 to 2.12; p = 0.235) and major adverse cardiac and cerebrovascular events (HR: 1.34, 95% CI: 0.93 to 1.93; p = 0.113). These results were sustained after propensity-score matching. However, a higher incidence of target vessel revascularization (HR: 1.94, 95% CI: 1.03 to 3.64; p = 0.039) was observed in the PCI compared with the CABG group, with a trend toward higher target lesion revascularization (HR: 2.00, 95% CI: 0.90 to 4.45; p = 0.090). This study demonstrates that PCI for ostial/midshaft lesions in an ULMCA is associated with clinical outcomes comparable to those observed with CABG at long-term follow-up, despite the use of older first-generation DES.

Naganuma T ，Chieffo A ，Meliga E ，Capodanno D ，Park SJ ，Onuma Y ，Valgimigli M ，Jegere S ，Makkar RR ，Palacios IF ，Costopoulos C ，Kim YH ，Buszman PP ，Chakravarty T ，Sheiban I ，Mehran R ，Naber C ，Margey R ，Agnihotri A ，Marra S ，Capranzano P ，Leon MB ，Moses JW ，Fajadet J ，Lefevre T ，Morice MC ，Erglis A ，Tamburino C ，Alfieri O ，Serruys PW ，Colombo A ... -  《-》

Long-term clinical outcomes after percutaneous coronary intervention for ostial/mid-shaft lesions versus distal bifurcation lesions in unprotected left main coronary artery: the DELTA Registry (drug-eluting stent for left main coronary artery disease): a

The aim of this study was to compare, in a large all-comer registry, the long-term clinical outcomes after percutaneous coronary intervention (PCI) with drug-eluting stents (DES) for ostial/mid-shaft lesions versus distal bifurcation lesions in unprotected left main coronary artery (ULMCA) stenosis. Limited data are available regarding clinical outcomes following DES implantation at the different ULMCA sites. Patients with ULMCA stenosis treated by PCI with DES were analyzed in this multinational registry. A total of 1,612 patients were included: 482 were treated for ostial/mid-shaft lesions versus 1,130 for distal bifurcation lesions. At a median follow-up period of 1,250 (interquartile range: 987 to 1,564) days, PCI for distal bifurcation lesions was associated with a higher incidence of major adverse cardiac events (propensity-score adjusted hazard ratio [HR]: 1.48, 95% confidence interval [CI]: 1.16 to 1.89; p = 0.001), largely because of the higher target vessel revascularization rate observed in this group as compared to the ostial/mid-shaft lesions group (propensity-score adjusted HR: 1.68, 95% CI: 1.19 to 2.38; p = 0.003). These results were sustained following propensity-score matched analysis. With regard to all-cause death and the composite endpoint of all-cause death and myocardial infarction, propensity-score adjusted analysis suggested a trend toward higher rates of these in the distal ULMCA PCI group, although this was not observed in the propensity-score matched analysis. This study demonstrates that PCI for ostial/mid-shaft lesions is associated with better clinical outcomes than are distal bifurcation lesions in ULMCA, largely because there is a lower need for repeat revascularization in ostial/mid-shaft lesions.

Naganuma T ，Chieffo A ，Meliga E ，Capodanno D ，Park SJ ，Onuma Y ，Valgimigli M ，Jegere S ，Makkar RR ，Palacios IF ，Costopoulos C ，Kim YH ，Buszman PP ，Chakravarty T ，Sheiban I ，Mehran R ，Naber C ，Margey R ，Agnihotri A ，Marra S ，Capranzano P ，Leon MB ，Moses JW ，Fajadet J ，Lefevre T ，Morice MC ，Erglis A ，Tamburino C ，Alfieri O ，Serruys PW ，Colombo A ... -  《-》

Midterm follow-up of patients with perioperative myocardial infarction after coronary artery bypass surgery: clinical significance of different treatment strategies.

The purpose of the study was to analyze the causes of postoperative myocardial infarction (PMI) and the impact of different treatment strategies on (1) postoperative outcome, (2) major adverse events (MACE), and (3) postoperative Canadian Cardiovascular Society (CCS) at 3-year follow-up. Between May 2001 and July 2006, 113 patients with PMI were categorized in three groups: (A) conservative therapy (50 patients); (B) percutaneous coronary intervention (PCI) (25 patients), and (C) re-CABG (38 patients). Overall in-hospital mortality was 7.1% (n = 8), being 10.0% in group A (n = 5), 4.0% in group B (n = 1) and 5.3% (n = 2) in group C (p = n.s.), respectively. The cumulative survival rates at 3 years were 90% for group A, 92% for group B, and 89.5% for group C (p = n.s). The MACE rate at 3-year follow-up for all patients was 27.4% and was significantly higher in group A (34%) and group B (36%) compared with group C (13.2%) (p = 0.05). Mean CCS was significantly reduced at follow-up in the groups compared with the preoperative angina class. However, group B and C showed a significant improvement in CCS compared with group A (p = 0.044/p < 0.001). Further group C was superior to group B (p = 0.032). At 3 years of follow-up, this study showed no survival benefits from any therapeutical procedure; however patients treated with re-CABG had better freedom from repeat revascularization procedures and from MACCE. In addition, the conservative and PCI group had a higher incidence of recurrence of angina.

Alexiou K ，Wilbring M ，Koch C ，Kappert U ，Tugtekin S ，Matschke K ... -  《-》