European Journal of Medical Research (Jul 2023)
Percutaneous coronary intervention vs. coronary artery bypass grafting in emergency and non-emergency unprotected left-main revascularization
- Amin Daoulah,
- Abdulrahman H. Alqahtani,
- Ahmed Elmahrouk,
- Nooraldaem Yousif,
- Wael Almahmeed,
- Amr A. Arafat,
- Turki Al Garni,
- Mohammed A. Qutub,
- Ziad Dahdouh,
- Mohammed Alshehri,
- Ahmad S. Hersi,
- Majed M. Malak,
- Syifa R. Djunaedi,
- Ayesha Zaidi,
- Maryam Jameel Naser,
- Wael Qenawi,
- Abdelmaksoud Elganady,
- Taher Hassan,
- Vincent Ball,
- Youssef Elmahrouk,
- Adnan Fathey Hussien,
- Badr Alzahrani,
- Reda Abuelatta,
- Ehab Selim,
- Ahmed Jamjoom,
- Khalid Z. Alshali,
- Shahrukh Hashmani,
- Wael Refaat,
- Hameedullah M. Kazim,
- Mohamed Ajaz Ghani,
- Haitham Amin,
- Ahmed M. Ibrahim,
- Abdulwali Abohasan,
- Mohamed N. Alama,
- Mohammed Balghith,
- Ibrahim A. M. Abdulhabeeb,
- Osama Ahmad,
- Mohamed Ramadan,
- Ahmed A. Ghonim,
- Abeer M. Shawky,
- Husam A. Noor,
- Abdulrahman M. Alqahtani,
- Faisal Al Samadi,
- Seraj Abualnaja,
- Rasha Taha Baqais,
- Abdulkarim Alhassoun,
- Issam Altnji,
- Mushira Khan,
- Abdulaziz Alasmari,
- Alwaleed Aljohar,
- Niranjan Hiremath,
- Jairam Aithal,
- Amir Lotfi
Affiliations
- Amin Daoulah
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center
- Abdulrahman H. Alqahtani
- Department of Emergency Medicine, King Abdulaziz Medical City
- Ahmed Elmahrouk
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center
- Nooraldaem Yousif
- Department of Cardiology, Mohammed Bin Khalifa Specialist Cardiac Center
- Wael Almahmeed
- Heart & Vascular Institute, Cleveland Clinic Abu Dhabi
- Amr A. Arafat
- Department of Cardiothoracic Surgery, Faculty of Medicine, Tanta University
- Turki Al Garni
- Department of Cardiology, Prince Sultan Cardiac Center
- Mohammed A. Qutub
- Cardiology Center of Excellence, Department of Medicine, King Abdulaziz University
- Ziad Dahdouh
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center
- Mohammed Alshehri
- Department of Cardiology, Prince Khaled Bin Sultan Cardiac Center
- Ahmad S. Hersi
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University
- Majed M. Malak
- Department of Medicine, King Abdulaziz University
- Syifa R. Djunaedi
- Department of Medicine, University of Massachusetts Chan Medical School - Baystate Medical Center
- Ayesha Zaidi
- Department of Medicine, University of Massachusetts Chan Medical School - Baystate Medical Center
- Maryam Jameel Naser
- Department of Medicine, Baystate Medical Center
- Wael Qenawi
- Department of Cardiology, Prince Khaled Bin Sultan Cardiac Center
- Abdelmaksoud Elganady
- Department of Cardiology, Dr. Erfan and Bagedo General Hospital
- Taher Hassan
- Department of Cardiology, Bugshan General Hospital
- Vincent Ball
- Department of Emergency Medicine, Cleveland Clinic
- Youssef Elmahrouk
- Faculty of Medicine, Tanta University
- Adnan Fathey Hussien
- Department of Cardiology, International Medical Center
- Badr Alzahrani
- Department of Cardiology, Prince Sultan Cardiac Center
- Reda Abuelatta
- Department of Cardiology, Madinah Cardiac Center
- Ehab Selim
- Department of Cardiology, Alhada Armed Forces Hospital
- Ahmed Jamjoom
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center
- Khalid Z. Alshali
- Department of Medicine, Faculty of Medicine, King Abdulaziz University
- Shahrukh Hashmani
- Heart & Vascular Institute, Cleveland Clinic Abu Dhabi
- Wael Refaat
- Department of Cardiology, Prince Sultan Cardiac Center
- Hameedullah M. Kazim
- Department of Cardiology, Alhada Armed Forces Hospital
- Mohamed Ajaz Ghani
- Department of Cardiology, Madinah Cardiac Center
- Haitham Amin
- Department of Cardiology, Mohammed Bin Khalifa Specialist Cardiac Center
- Ahmed M. Ibrahim
- Department of Cardiology, Saudi German Hospital
- Abdulwali Abohasan
- Department of Cardiology, Prince Sultan Cardiac Center
- Mohamed N. Alama
- Cardiology Center of Excellence, Department of Medicine, King Abdulaziz University
- Mohammed Balghith
- King Abdulaziz Cardiac Center, College of Medicine, King Saud Bin Abdulaziz University for Health Science
- Ibrahim A. M. Abdulhabeeb
- Department of Cardiology, King Abdulaziz Specialist Hospital
- Osama Ahmad
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center
- Mohamed Ramadan
- Department of Cardiology, Prince Sultan Cardiac Center
- Ahmed A. Ghonim
- Cardiology Center of Excellence, Department of Medicine, King Abdulaziz University
- Abeer M. Shawky
- Department of Cardiology, Dr. Erfan and Bagedo General Hospital
- Husam A. Noor
- Department of Cardiology, Mohammed Bin Khalifa Specialist Cardiac Center
- Abdulrahman M. Alqahtani
- Department of Cardiology, King Fahad Medical City, King Salman Heart Center
- Faisal Al Samadi
- Department of Cardiology, King Fahad Medical City, King Salman Heart Center
- Seraj Abualnaja
- Department of Cardiology, International Medical Center
- Rasha Taha Baqais
- Department of Cardiac Surgery, King Fahd Armed Forces Hospital
- Abdulkarim Alhassoun
- Department of Anesthesia, King Faisal Specialist Hospital & Research Center
- Issam Altnji
- Department of Cardiology, Our Lady of Lourdes Hospital
- Mushira Khan
- Al Faisal University
- Abdulaziz Alasmari
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center
- Alwaleed Aljohar
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University
- Niranjan Hiremath
- Heart & Vascular Institute, Cleveland Clinic Abu Dhabi
- Jairam Aithal
- Department of Cardiology, Yas Clinic
- Amir Lotfi
- Department of Cardiovascular Medicine, University of Massachusetts Chan Medical School - Baystate Medical Center
- DOI
- https://doi.org/10.1186/s40001-023-01189-1
- Journal volume & issue
-
Vol. 28,
no. 1
pp. 1 – 14
Abstract
Abstract Background The optimal revascularization strategy in patients with left main coronary artery (LMCA) disease in the emergency setting is still controversial. Thus, we aimed to compare the outcomes of percutaneous coronary interventions (PCI) vs. coronary artery bypass grafting (CABG) in patients with and without emergent LMCA disease. Methods This retrospective cohort study included 2138 patients recruited from 14 centers between 2015 and 2019. We compared patients with emergent LMCA revascularization who underwent PCI (n = 264) to patients who underwent CABG (n = 196) and patients with non-emergent LMCA revascularization with PCI (n = 958) to those who underwent CABG (n = 720). The study outcomes were in-hospital and follow-up all-cause mortality and major adverse cardiovascular and cerebrovascular events (MACCE). Results Emergency PCI patients were older and had a significantly higher prevalence of chronic kidney disease, lower ejection fraction, and higher EuroSCORE than CABG patients. CABG patients had significantly higher SYNTAX scores, multivessel disease, and ostial lesions. In patients presenting with arrest, PCI had significantly lower MACCE (P = 0.017) and in-hospital mortality (P = 0.016) than CABG. In non-emergent revascularization, PCI was associated with lower MACCE in patients with low (P = 0.015) and intermediate (P < 0.001) EuroSCORE. PCI was associated with lower MACCE in patients with low (P = 0.002) and intermediate (P = 0.008) SYNTAX scores. In non-emergent revascularization, PCI was associated with reduced hospital mortality in patients with intermediate (P = 0.001) and high (P = 0.002) EuroSCORE compared to CABG. PCI was associated with lower hospital mortality in patients with low (P = 0.031) and intermediate (P = 0.001) SYNTAX scores. At a median follow-up time of 20 months (IQR: 10–37), emergency PCI had lower MACCE compared to CABG [HR: 0.30 (95% CI 0.14–0.66), P < 0.003], with no significant difference in all-cause mortality between emergency PCI and CABG [HR: 1.18 (95% CI 0.23–6.08), P = 0.845]. Conclusions PCI could be advantageous over CABG in revascularizing LMCA disease in emergencies. PCI could be preferred for revascularization of non-emergent LMCA in patients with intermediate EuroSCORE and low and intermediate SYNTAX scores.
Keywords