Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Apr 29:9:849971.
doi: 10.3389/fcvm.2022.849971. eCollection 2022.

Percutaneous Coronary Intervention vs. Coronary Artery Bypass Grafting for Treating In-Stent Restenosis in Unprotected-Left Main: LM-DRAGON-Registry

Wojciech Wańha  1 , Jacek Bil  2 , Michalina Kołodziejczak  3   4 , Adam Kowalówka  5 , Mariusz Kowalewski  6   7   8 , Damian Hudziak  5 , Radosław Gocoł  5 , Rafał Januszek  9 , Tomasz Figatowski  10 , Marek Milewski  1 , Brunon Tomasiewicz  11 , Piotr Kübler  11 , Bruno Hrymniak  11 , Piotr Desperak  12 , Łukasz Kuźma  13 , Krzysztof Milewski  14 , Bartłomiej Góra  14 , Andrzej Łoś  15 , Jan Kulczycki  16 , Adrian Włodarczak  16 , Wojciech Skorupski  17 , Marek Grygier  17 , Maciej Lesiak  17 , Fabrizio D'Ascenzo  18 , Marek Andres  19 , Paweł Kleczynski  19 , Radosław Litwinowicz  20 , Andrea Borin  18 , Grzegorz Smolka  1 , Krzysztof Reczuch  11 , Marcin Gruchała  10 , Robert J Gil  2 , Miłosz Jaguszewski  10 , Krzysztof Bartuś  20 , Piotr Suwalski  6 , Sławomir Dobrzycki  13 , Dariusz Dudek  9 , Stanisław Bartuś  9 , Mariusz Ga Sior  12 , Andrzej Ochała  1 , Alexandra J Lansky  4 , Marek Deja  5 , Jacek Legutko  19 , Elvin Kedhi  1   21 , Wojciech Wojakowski  1
Affiliations

Percutaneous Coronary Intervention vs. Coronary Artery Bypass Grafting for Treating In-Stent Restenosis in Unprotected-Left Main: LM-DRAGON-Registry

Wojciech Wańha et al. Front Cardiovasc Med. .

Abstract

Background: Data regarding management of patients with unprotected left main coronary artery in-stent restenosis (LM-ISR) are scarce.

Objectives: This study investigated the safety and effectiveness of percutaneous coronary intervention (PCI) vs. coronary artery bypass grafting (CABG) for the treatment of unprotected LM-ISR.

Methods: Consecutive patients who underwent PCI or CABG for unprotected LM-ISR were enrolled. The primary endpoint was a composite of major adverse cardiac and cerebrovascular events (MACCE), defined as cardiac death, myocardial infarction (MI), target vessel revascularization (TVR), and stroke.

Results: A total of 305 patients were enrolled, of which 203(66.6%) underwent PCI and 102(33.4%) underwent CABG. At 30-day follow-up, a lower risk of cardiac death was observed in the PCI group, compared with the CABG-treated group (2.1% vs. 7.1%, HR 3.48, 95%CI 1.01-11.8, p = 0.04). At a median of 3.5 years [interquartile range (IQR) 1.3-5.5] follow-up, MACCE occurred in 27.7% vs. 29.6% (HR 0.82, 95%CI 0.52-1.32, p = 0.43) in PCI- and CABG-treated patients, respectively. There were no significant differences between PCI and CABG in cardiac death (9.9% vs. 18.4%; HR 1.56, 95%CI 0.81-3.00, p = 0.18), MI (7.9% vs. 5.1%, HR 0.44, 95%CI 0.15-1.27, p = 0.13), or stroke (2.1% vs. 4.1%, HR 1.79, 95%CI 0.45-7.16, p = 0.41). TVR was more frequently needed in the PCI group (15.2% vs. 6.1%, HR 0.35, 95%CI 0.15-0.85, p = 0.02).

Conclusions: This analysis of patients with LM-ISR revealed a lower incidence of cardiac death in PCI compared with CABG in short-term follow-up. During the long-term follow-up, no differences in MACCE were observed, but patients treated with CABG less often required TVR.

Visual overview: A visual overview is available for this article.

Registration: https://www.clinicaltrials.gov; Unique identifier: NCT04968977.

Keywords: coronary artery bypass graft (CABG); in-stent restenosis (ISR); left main; percutaneous coronary intervention (complex PCI); stents (Coronary).

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Kaplan–Meier curves for MACCE according to type of treatment. Major adverse cardiac and cerebrovascular events (MACCE) is the composite of target vessel revascularization, myocardial infarction, stroke, or cardiac death. CABG, coronary artery bypass grafting; PCI, percutaneous coronary intervention.
Figure 2
Figure 2
Kaplan–Meier curves for cumulative incidence of secondary outcomes according to type of treatment. CABG, coronary artery bypass grafting; MI, myocardial infarction; PCI, percutaneous coronary intervention; TVR, target vessel revascularization.
Figure 3
Figure 3
Risk of MACCE at long-term follow-up. CABG, coronary artery bypass grafting; CI, confidence interval; CKD, chronic kidney disease; HR, hazard ratio; ISR, in-stent restenosis; LM, left main coronary artery; LVEF, left ventricular ejection fraction; MI, myocardial infarction; PCI, percutaneous coronary intervention; STS, Society of Thoracic Surgeons.
See this image and copyright information in PMC

References

    1. Stone GW, Kappetein AP, Sabik JF, Pocock SJ, Morice MC, Puskas J, et al. . Five-Year outcomes after PCI or CABG for left main coronary disease. N Engl J Med. (2019) 381:1820–30. 10.1056/NEJMoa1909406 - DOI - PubMed
    1. Makikallio T, Holm NR, Lindsay M, Spence MS, Erglis A, Menown IB, et al. . Percutaneous coronary angioplasty versus coronary artery bypass grafting in treatment of unprotected left main stenosis (NOBLE): a prospective, randomised, open-label, non-inferiority trial. Lancet. (2016) 388:2743–52. 10.1016/S0140-6736(16)32052-9 - DOI - PubMed
    1. Sheiban I, Sillano D, Biondi-Zoccai G, Chieffo A, Colombo A, Vecchio S, et al. . Incidence and management of restenosis after treatment of unprotected left main disease with drug-eluting stents 70 restenotic cases from a cohort of 718 patients: FAILS (Failure in Left Main Study). J Am Coll Cardiol. (2009) 54:1131–6. 10.1016/j.jacc.2009.06.018 - DOI - PubMed
    1. Lee JY, Park DW, Kim YH, Yun SC, Kim WJ, Kang SJ, et al. . Incidence, predictors, treatment, and long-term prognosis of patients with restenosis after drug-eluting stent implantation for unprotected left main coronary artery disease. J Am Coll Cardiol. (2011) 57:1349–58. 10.1016/j.jacc.2010.10.041 - DOI - PubMed
    1. Mehran R, Dangas G, Abizaid AS, Mintz GS, Lansky AJ, Satler LF, et al. . Angiographic patterns of in-stent restenosis: classification and implications for long-term outcome. Circulation. (1999) 100:1872–8. 10.1161/01.CIR.100.18.1872 - DOI - PubMed

Associated data