Search

Background Women have worse outcomes than men after PCI, with some studies suggesting a lower mortality of CABG vs PCI in females. Purpose To assess the outcomes of CABG and PCI according to sex in a large registry population of patients with unprotected left main coronary artery (ULMCA) disease. Methods The DELTA and DELTA 2 registries are two multicentric, prospective registries evaluating the outcomes of subjects undergoing coronary revascularization for ULMCA disease. Results Total population was 6253 patients, 27% women. Table 1 shows baseline clinical characteristics. Median follow up was of 880 days. Women undergoing CABG had lower incidence of death, myocardial infarction (MI) or cerebrovascular accidentc (CVA) (HR 0.53, 95% CI 0.35–0.79) and a lower risk of death (HR 0.40, 95% CI 0.24–0.67). No significant differences were observed in men (Figure 1A). SIgnificant interaction was observed between sex and revascularization strategy for both outcomes (p Conclusions In women undergoing coronary revascularization for ULMCA disease, CABG is associated to lower risk of death, MI or CVA. Further dedicated studies are needed to determine the optimal revascularization strategy in women with ULMCA disease. Figure 1 Funding Acknowledgement Type of funding source: None

Background Limited data exist on the optimal revascularization strategy for patients with left main coronary artery disease (LMCAD) and chronic kidney disease (CKD). We conducted a meta-analysis to compare the outcomes of coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) in this population. Methods Multiple electronic databases were queried for studies comparing CABG and PCI in CKD patients undergoing LMCAD (>50% diameter stenosis) revascularization. CKD was defined as estimated glomerular filtration rate of Results Six studies (4 observational, 2 randomized controlled trials) met inclusion criteria with a total of 2051 patients (CABG: 977, PCI: 1074). Patients undergoing CABG had a higher incidence of multi-vessel disease (74.7% vs 65.7%, p=0.01). At a mean follow-up of 3.4±1.1 years, MACCE was significantly lower in the CABG group (OR = 0.70, 95% CI 0.57–0.87; p=0.001) (Figure 1). The odds of MI or repeat revascularization were lower with CABG, whereas the odds of stroke were higher; no statistically-significant difference was seen in all-cause mortality. Conclusion This meta-analysis shows that CABG is associated with lower rates of MACCE and MI but with a higher rate of stroke compared to PCI in LMCAD patients with CKD. Funding Acknowledgement Type of funding source: None

Background Percutaneous coronary intervention (PCI) of unprotected left main coronary artery disease is currently recommended as an alternative to coronary artery bypass grafting (CABG) in patients with low and intermediate SYNTAX score. Purpose We sought to compare clinical outcomes of unprotected left main coronary artery disease by PCI or CABG in a “real world” population referred to high volume center. Methods All consecutive patients with unprotected left main coronary artery disease treated by PCI with second-generation drug-eluting stent were compared to those treated by CABG. The primary endpoint was the composite of death, non-fatal myocardial infarction (MI) or stroke at 2 years follow-up. Results A total of 558 patients were included. The mean age was 71±9 years, diabetes was present in 29%, and 56% of the patients presented with acute coronary syndrome. The distal left main coronary artery was involved in 84.6% of the lesions, the rate of Syntax score >32 was 50%. At 2 years, the primary end-point occurred in 10% of the patients in the PCI group and in 9.6% in the CABG group (p=0.862). The rates of death, non-fatal MI or stroke at 2 years were comparable; conversely the rate of ischemia driven revascularization at 2 years was higher in PCI group than CABG (5.5% and 1.5% p=0.010, respectively in PCI and CABG group). Kaplan-Meier curves of MACCE Conclusions In a “real world” population with unprotected left main coronary artery disease, PCI with second generation stent, as compared to CABG, showed similar rates of the composite end point of death, non-fatal MI or stroke at 2 years, irrespective of coronary anatomy complexity.

Purpose: In spite of being a complex calculation, reports of interobserver variability between interventional cardiologists (IC) of the SYNTAX score (SS) are limited. The objectives of this study are: a) report the interobserver variability of the SS between ICs, b) detect the main source of discrepancy. Methods: 98 consecutive angiograms with left main and/or three vessel disease were selected. Two ICs calculated the total SS. Results were analyzed categorically with linear weighted Kappa (k), quantitatively with concordance correlation coefficient (CCC) and visually through Bland Altman plot. The number of lesions observed by patient, presence of left main disease, number of bifurcations and total occlusions were analyzed by k. After establishing significant discrepancy of SS as more than the 50th percentile of the total error committed, logistic regression was performed in order to detect which characteristics were associated with high discrepancy. Results: The median SS was 28.5 (IQ: 22-36) and 29 (IQ: 22-41) for both ICs. The k was 0.70 (95% CI 0.59 to 0.81) and 0.64 (95% CI 0.54 to 0.74) for tertiles and deciles respectively. The CCC was 0,82 (CI 95% 0,75 - 0,87). Visual analysis is compatible with good agreement between observers (Figure). The k of lesions was 0,76, left main disease 0,83, bifurcacions 0,55 and occlussions 0,95. The 50th percentile of discrepancy was 4 points. Only the disagreement on the number of lesions per patient was associated with a discrepancy of more than 4 points (OR 3.72, 95% CI 1.54 to 8.99). ![Figure][1] Bland Altman Conclusions: We detected an acceptable level of agreement of the SS between ICs. Although variability of lesions per patient was acceptable, their disagreement was the only factor associated with a significant error in the assessment of the SS. [1]: pending:yes