Author + information
- Alberto Repossini1,
- Alfonso Ielasi2,
- Lorenzo Di Bacco3,
- Claudio Gentilini4,
- Antonio Saino5,
- Giulietta Grigis6,
- Davide Personeni7,
- Claudio Muneretto1 and
- Maurizio Tespili8
- 1Spedali Civili di Brescia, Brescia, Brescia, Italy
- 2Ospedale Bolognini, Seriate, Bergamo, Italy
- 3Spedali Civili Brescia, Brescia, Brescia, Italy
- 4Ospedale Mellino Mellini, Chairi, Brescia, Italy
- 5A.O. Bolognini-ASST Bergamo Est, Seriate, Bergamo, Italy
- 6Azienda Ospedaliera Bolognini Seriate, Bergamo, Italy, Seriate, Bergamo, Italy
- 7Bolognini, Seriate, Italy
- 8ASST Bergamo Est, Ospedale Bolognini, Seriate, Bergamo, Italy
Hybrid coronary revascularization (HCR) has been recently proposed as an effective alternative revascularization strategy in patients with multi-vessel coronary artery disease (CAD). However there is lack of data concerning patients with unprotected left main(ULM) stenosis. Objective of this study is to evaluate the outcomes of HCR versus PCI in patients with severe ULM narrowings.
From 2013 to 2016, 198 patients with severe ULM lesions underwent myocardial revascularization after Heart Team discussion. Seventy-seven patients (G1) were treated with HCR, MIDCAB associated to PCI with DES on non-LAD vessels, while 121 patients (G2) received PCI with DES implantation on ULM (plus other vessels if required). An adjusted analysis using inverse probability weighting (IPW) was performed and two groups of 67 patients (G1) and 101 (G2) were obtained. Primary end-points were 30-day MACCEs (a composite of death, stroke, and myocardial infarction) and 18-months MACCEs. Secondary end-points were the incidence 30-day overall death, ULM-related target lesion revascularization (ULM-TLR) and target vessel revascularization (TVR).
Mean patient age was 69±9 years in G1 and 69±10 years in G2. Diabetics were 26.8% of patients in G1 while 30.8% in G2. A total of 28 (16.6%) patients had an acute coronary syndrome at admission (11 patients in G1 and 17 patients in G2). SYNTAX score was 28.8±6.1 in G1 and 28.3±5.9 in G2 (p=0.529). MACCEs rate at 30 days was 1.5% in G1 versus 4.9% in G2 (p=0.285). Overall 30-days mortality was 2.7% in G2 and 0% in G1 (p=0.603) No mortality at 18-months follow-up was reported in both groups. A trend for a lower hazard incidence for MACCEs at 18 months follow-up was reported in G1 (G1: 3.1±1.3% vs G2 9.3±4.2%; p=0.067) as well as incidence of ULM-TLR (G1: 4.8±2.2% vs G2 12.8±5.6%; p=0.071). Incidence of TVR at 18-months was significantly higher in G2 (G1: 6.7±3.2% vs G2 18.1±4.8%; p=0.012).
In this study HCR (MID-CAB plus PCI with DES implantation) was associated with a trend for lower 30-day and 18 months MACCE versus a PCI only approachLarger and adequately powered comparative studies are needed to clarify the role of HCR in the setting of ULM disease.
CORONARY: Hybrid Revascularization