Author + information
- Received March 18, 2020
- Revision received July 6, 2020
- Accepted July 20, 2020
- Published online September 14, 2020.
- Sangwoo Park, MDa,
- Jung-Min Ahn, MDb,
- Tae Oh Kim, MDb,
- Hanbit Park, MDb,
- Do-Yoon Kang, MDb,
- Pil Hyung Lee, MDb,
- Yeong Jin Jeong, MDb,
- Junho Hyun, MDb,
- Junghoon Lee, MDb,
- Ju Hyeon Kim, MDb,
- Yujin Yang, MDb,
- Kyungjin Choe, MDb,
- Seung-Jung Park, MDb,
- Duk-Woo Park, MDb,∗ (, )@dukwoo_park,
- for the IRIS-MAIN Registry Investigators
- aDepartment of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
- bDepartment of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- ↵∗Address for correspondence:
Dr. Duk-Woo Park, Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea.
Background Left main coronary artery (LMCA) disease is associated with high mortality and morbidity due to a large area of jeopardized myocardium. However, the optimal revascularization strategy for patients with LMCA disease and left ventricular dysfunction is still unclear.
Objectives This study sought to examine long-term comparative outcomes after percutaneous coronary intervention (PCI) or a coronary artery bypass grafting (CABG) according to the severity of left ventricular dysfunction.
Methods The authors evaluated a total of 3,488 patients with LMCA disease who underwent CABG (n = 1,355) or PCI (n = 2,133) from the IRIS-MAIN (Interventional Research Incorporation Society-Left MAIN Revascularization) registry. Left ventricular function was categorized according to left ventricular ejection fraction (LVEF) as normal function (LVEF ≥55%), mild dysfunction (LVEF ≥45% to <55%), moderate dysfunction (LVEF ≥35% to <45%), or severe dysfunction (LVEF <35%). The primary outcome was a composite of death, myocardial infarction, or stroke.
Results Among the overall patient population, 2,641 (75.7%) patients had normal LVEF and 403 (11.6%), 260 (7.5%), and 184 (5.3%) had mild, moderate, and severe left ventricular dysfunction at baseline, respectively. Compared with CABG, PCI was associated with a higher adjusted risk of primary outcomes in patients with moderate (hazard ratio [HR]: 2.23; 95% confidence interval [CI]: 1.17 to 4.28) or severe (HR: 2.45; 95% CI: 1.27 to 4.73) dysfunction. In contrast, PCI and CABG had similar risks of the primary outcomes in patients with normal (HR: 0.80; 95% CI: 0.59 to 1.07) or mild (HR: 1.17; 95% CI: 0.63 to 2.17) dysfunction (p for interaction = 0.004).
Conclusions In the revascularization of LMCA disease, PCI was associated with an inferior primary composite outcome of death, MI, or stroke compared with CABG in patients with moderate or severe left ventricular dysfunction. However, the risk for the primary outcome was comparable between PCI and CABG in those with normal or mild left ventricular dysfunction. (Observational Study for Left Main Disease Treatment; NCT01341327)
- coronary artery bypass grafting
- left main coronary artery disease
- percutaneous coronary intervention
- ventricular dysfunction
This work was partly supported by a grant from the Cardiovascular Research Foundation of South Korea. The sponsors played no role in this study. There was no industry involvement in the design or conduct of the study; the collection, management, analysis, and interpretation of the data; the preparation, review, and approval of the manuscript; or the decision to submit the manuscript for publication. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC author instructions page.
- Received March 18, 2020.
- Revision received July 6, 2020.
- Accepted July 20, 2020.
- 2020 American College of Cardiology Foundation
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