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

J. Matthew Brennan, David Dai, Manesh R. Patel, Sunil V. Rao, Ehrin J. Armstrong, John C. Messenger, Jeptha P. Curtis, Kendrick A. Shunk, Kevin J. Anstrom, Eric L. Eisenstein, William S. Weintraub, Eric D. Peterson, Pamela S. Douglas, William B. Hillegass

Research output: Contribution to journalArticle

40 Citations (Scopus)

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 languageEnglish (US)
Pages (from-to)648-654
Number of pages7
JournalJournal of the American College of Cardiology
Volume59
Issue number7
DOIs
StatePublished - Feb 14 2012
Externally publishedYes

Fingerprint

Coronary Stenosis
Percutaneous Coronary Intervention
Registries
Coronary Vessels
Stents
Myocardial Revascularization
Hospital Mortality
Mortality
Metals
Myocardial Infarction
Confidence Intervals
Drug-Eluting Stents
Medicare
Catheterization
Coronary Artery Disease

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 journalArticle

Brennan, JM, Dai, D, Patel, MR, Rao, SV, Armstrong, EJ, Messenger, JC, Curtis, JP, Shunk, KA, Anstrom, KJ, Eisenstein, EL, Weintraub, WS, Peterson, ED, Douglas, PS & Hillegass, WB 2012, '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', Journal of the American College of Cardiology, vol. 59, no. 7, pp. 648-654. https://doi.org/10.1016/j.jacc.2011.10.883
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. / 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. In: Journal of the American College of Cardiology. 2012 ; Vol. 59, No. 7. pp. 648-654.
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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.",
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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

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