title: Early and long-term outcomes after surgical and percutaneous myocardial revascularization in patients with non-ST-elevation acute coronary syndromes and unprotected left main disease.
abstract: Surgical myocardial revascularization (CABG) in patients with unprotected left main coronary artery disease (ULMCA) is a Class I recommendation in the AHA/ACC guidelines, however it is associated with increased perioperative risk in non-ST elevation acute coronary syndromes (NSTE-ACS). The aim of this study was to compare early and late results after percutaneous coronary intervention (PCI) and CABG in this cohort of patients.
  
  
  METHODS
  A multicenter prospective registry included 138 patients with patent but severely narrowed (> 50%) ULMCA disease and NSTE-ACS diagnosed between January 2005 and April 2007. After emergent coronary angiography, 63 patients underwent PCI, whiles 75 were assigned for CABG.
  
  
  RESULTS
  Groups were comparable with regard to sex, age and prevalence of diabetes mellitus (DM). They had similar left ventricular ejection fraction, SYNTAX Score and incidence of distal LM stenosis. However, PCI patients were at higher surgical risk (Euroscore 8.7 +/- 3.7 vs. 7.4 +/- 3.0; p = 0.02) and myocardial infarction incidence (28% vs. 14%; p = 0.07). The 30-day mortality was 1.5% after PCI vs. 12% after CABG (p = 0.043) and major adverse cardiovascular and cerebrovascular events (MACCE) were 3.2% vs. 14.7%, respectively (p = 0.04). After 12 months, there were 4 deaths in the PCI group and 12 deaths in the CABG group (6.3% vs. 16%; p = 0.14). There was no difference in MACCE (9.5% vs. 9.3% p = ns). Kaplan-Meier analysis revealed a trend toward better survival after PCI (p = 0.07). Revascularization with CABG and a Euroscore > 5 were the independent risk factors influencing early survival, while a Euroscore > 6 was the independent predictor of late mortality.
  
  
  CONCLUSIONS
  PCI is a reasonable alternative to CABG in patients with NSTE-ACS and ULMCA stenosis.
authors.affiliation: Medical University of Silesia, Katowice, Poland.
authors.forename: Piotr P
authors.initials: PP
authors.lastname: Buszman
authors.forename: Andrzej
authors.initials: A
authors.lastname: Bochenek
authors.forename: Magda
authors.initials: M
authors.lastname: Konkolewska
authors.forename: Blazej
authors.initials: B
authors.lastname: Trela
authors.forename: R Stefan
authors.initials: RS
authors.lastname: Kiesz
authors.forename: Mirosław
authors.initials: M
authors.lastname: Wilczyński
authors.forename: Marek
authors.initials: M
authors.lastname: Cisowski
authors.forename: Michał
authors.initials: M
authors.lastname: Krejca
authors.forename: Iwona
authors.initials: I
authors.lastname: Banasiewicz-Szkróbka
authors.forename: Marek
authors.initials: M
authors.lastname: Krol
authors.forename: Marek
authors.initials: M
authors.lastname: Kondys
authors.forename: Szymon
authors.initials: S
authors.lastname: Wiernek
authors.forename: Bartłomiej
authors.initials: B
authors.lastname: Orlik
authors.forename: Jack L
authors.initials: JL
authors.lastname: Martin
authors.forename: Michał
authors.initials: M
authors.lastname: Tendera
authors.forename: Pawel E
authors.initials: PE
authors.lastname: Buszman
mesh_terms: D054058:Acute Coronary Syndrome / Q000401:mortality / Q000601:surgery / Q000628:therapy; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000401:mortality*; D001026:Coronary Artery Bypass / Q000401:mortality*; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery / Q000628:therapy; D018572:Disease-Free Survival; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012042:Registries / Q000706:statistics & numerical data; D012307:Risk Factors; D015607:Stents / Q000706:statistics & numerical data*; D016896:Treatment Outcome