Abstract
Objectives: This study sought to assess percutaneous coronary intervention (PCI) for unprotected left main coronary artery (ULMCA) stenosis in routine U.S. clinical practice. Background: Percutaneous coronary intervention for ULMCA stenosis is controversial; however, current use and outcomes of ULMCA PCI in routine U.S. clinical practice have not been described. Methods: We evaluated 5,627 patients undergoing ULMCA PCI at 693 centers within the National Cardiovascular Data Registry Catheterization Percutaneous Coronary Intervention Registry for temporal trends in PCI use (2004 to 2008), patient characteristics, and in-hospital mortality. Thirty-month mortality and composite major adverse events (death, myocardial infarction, and revascularization) with drug-eluting versus bare-metal stents were compared using inverse probability weighted (IPW) hazard ratios (HRs) in a nonrandomized Medicare-linked (age <65 years) patient cohort (n = 2,765). Results: ULMCA PCI was performed in 4.3% of patients with ULMCA stenosis. Unadjusted in-hospital mortality rates ranged from 2.9% for elective cases to 45.1% for emergent/salvage cases. By 30 months, 57.9% of the elderly ULMCA PCI population experienced death, myocardial infarction, or revascularization, and 42.7% died. Patients receiving drug-eluting stents (versus bare-metal stents) had a lower 30-month mortality (IPW HR: 0.84, 95% confidence interval [CI]: 0.73 to 0.96), but the composite of major adverse events were similar (IPW HR: 0.95, 95% CI: 0.84 to 1.06). Conclusions: In the United States, ULMCA PCI is performed in <5% of patients with ULMCA disease and is generally reserved for those at high procedural risk. Adverse events are common in elderly patients and are related to patient and procedural characteristics, including stent type.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 648-654 |
| Number of pages | 7 |
| Journal | Journal of the American College of Cardiology |
| Volume | 59 |
| Issue number | 7 |
| DOIs | |
| State | Published - Feb 14 2012 |
| Externally published | Yes |
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Keywords
- long-term outcomes
- percutaneous revascularization
- unprotected left main coronary artery stenosis
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
Cite this
Characteristics and long-term outcomes of percutaneous revascularization of unprotected left main coronary artery stenosis in the United States : A report from the national cardiovascular data registry, 2004 to 2008. / Brennan, J. Matthew; Dai, David; Patel, Manesh R.; Rao, Sunil V.; Armstrong, Ehrin J.; Messenger, John C.; Curtis, Jeptha P.; Shunk, Kendrick A.; Anstrom, Kevin J.; Eisenstein, Eric L.; Weintraub, William S.; Peterson, Eric D.; Douglas, Pamela S.; Hillegass, William B.
In: Journal of the American College of Cardiology, Vol. 59, No. 7, 14.02.2012, p. 648-654.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Characteristics and long-term outcomes of percutaneous revascularization of unprotected left main coronary artery stenosis in the United States
T2 - A report from the national cardiovascular data registry, 2004 to 2008
AU - Brennan, J. Matthew
AU - Dai, David
AU - Patel, Manesh R.
AU - Rao, Sunil V.
AU - Armstrong, Ehrin J.
AU - Messenger, John C.
AU - Curtis, Jeptha P.
AU - Shunk, Kendrick A.
AU - Anstrom, Kevin J.
AU - Eisenstein, Eric L.
AU - Weintraub, William S.
AU - Peterson, Eric D.
AU - Douglas, Pamela S.
AU - Hillegass, William B.
PY - 2012/2/14
Y1 - 2012/2/14
N2 - Objectives: This study sought to assess percutaneous coronary intervention (PCI) for unprotected left main coronary artery (ULMCA) stenosis in routine U.S. clinical practice. Background: Percutaneous coronary intervention for ULMCA stenosis is controversial; however, current use and outcomes of ULMCA PCI in routine U.S. clinical practice have not been described. Methods: We evaluated 5,627 patients undergoing ULMCA PCI at 693 centers within the National Cardiovascular Data Registry Catheterization Percutaneous Coronary Intervention Registry for temporal trends in PCI use (2004 to 2008), patient characteristics, and in-hospital mortality. Thirty-month mortality and composite major adverse events (death, myocardial infarction, and revascularization) with drug-eluting versus bare-metal stents were compared using inverse probability weighted (IPW) hazard ratios (HRs) in a nonrandomized Medicare-linked (age <65 years) patient cohort (n = 2,765). Results: ULMCA PCI was performed in 4.3% of patients with ULMCA stenosis. Unadjusted in-hospital mortality rates ranged from 2.9% for elective cases to 45.1% for emergent/salvage cases. By 30 months, 57.9% of the elderly ULMCA PCI population experienced death, myocardial infarction, or revascularization, and 42.7% died. Patients receiving drug-eluting stents (versus bare-metal stents) had a lower 30-month mortality (IPW HR: 0.84, 95% confidence interval [CI]: 0.73 to 0.96), but the composite of major adverse events were similar (IPW HR: 0.95, 95% CI: 0.84 to 1.06). Conclusions: In the United States, ULMCA PCI is performed in <5% of patients with ULMCA disease and is generally reserved for those at high procedural risk. Adverse events are common in elderly patients and are related to patient and procedural characteristics, including stent type.
AB - Objectives: This study sought to assess percutaneous coronary intervention (PCI) for unprotected left main coronary artery (ULMCA) stenosis in routine U.S. clinical practice. Background: Percutaneous coronary intervention for ULMCA stenosis is controversial; however, current use and outcomes of ULMCA PCI in routine U.S. clinical practice have not been described. Methods: We evaluated 5,627 patients undergoing ULMCA PCI at 693 centers within the National Cardiovascular Data Registry Catheterization Percutaneous Coronary Intervention Registry for temporal trends in PCI use (2004 to 2008), patient characteristics, and in-hospital mortality. Thirty-month mortality and composite major adverse events (death, myocardial infarction, and revascularization) with drug-eluting versus bare-metal stents were compared using inverse probability weighted (IPW) hazard ratios (HRs) in a nonrandomized Medicare-linked (age <65 years) patient cohort (n = 2,765). Results: ULMCA PCI was performed in 4.3% of patients with ULMCA stenosis. Unadjusted in-hospital mortality rates ranged from 2.9% for elective cases to 45.1% for emergent/salvage cases. By 30 months, 57.9% of the elderly ULMCA PCI population experienced death, myocardial infarction, or revascularization, and 42.7% died. Patients receiving drug-eluting stents (versus bare-metal stents) had a lower 30-month mortality (IPW HR: 0.84, 95% confidence interval [CI]: 0.73 to 0.96), but the composite of major adverse events were similar (IPW HR: 0.95, 95% CI: 0.84 to 1.06). Conclusions: In the United States, ULMCA PCI is performed in <5% of patients with ULMCA disease and is generally reserved for those at high procedural risk. Adverse events are common in elderly patients and are related to patient and procedural characteristics, including stent type.
KW - long-term outcomes
KW - percutaneous revascularization
KW - unprotected left main coronary artery stenosis
UR - http://www.scopus.com/inward/record.url?scp=84857029575&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84857029575&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2011.10.883
DO - 10.1016/j.jacc.2011.10.883
M3 - Article
C2 - 22322080
AN - SCOPUS:84857029575
VL - 59
SP - 648
EP - 654
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
SN - 0735-1097
IS - 7
ER -