Abstract
BackgroundRecent randomized controlled trials have sparked debate about the optimal treatment of patients suffering from left main coronary artery disease. The present study analyzes outcomes of left main stenting versus coronary bypass grafting (CABG) in a nationwide registry in patients with chronic coronary syndrome (CCS).MethodsAll cases suffering from CCS and left main coronary artery disease treated either with CABG or stent, were identified within the database of the German bureau of statistics. Logistic or linear regression models were used with 20 baseline patient characteristics as potential confounders to compare both regimens.ResultsIn 2018, 1318 cases with left main stenosis were treated with CABG and 8,920 with stent. Patients assigned for stenting were older (72.58 ± 9.87 vs. 68.63 ± 9.40, p < 0.001) and at higher operative risk, as assessed by logistic EuroSCORE (8.77 ± 8.45 vs. 4.85 ± 4.65, p < 0.001). After risk adjustment, no marked differences in outcomes were found for in-hospital mortality and stroke (risk adjusted odds ratio (aOR) for stent instead of CABG: aOR mortality: 1.08 [95% CI 0.66; 1.78], p = 0.748; aOR stroke: 0.59 [0.27; 1.32], p = 0.199). Stent implantation was associated with a reduced risk of relevant bleeding (aOR 0.38 [0.24; 0.61], p < 0.001), reduced prolonged ventilation time (aOR 0.54 [0.37 0.79], p = 0.002), and postoperative delirium (aOR 0.16 [0.11; 0.22], p < 0.001). Furthermore, stent implantation was associated with shorter hospital stay (− 6.78 days [− 5.86; − 7.71], p < 0.001) and lower costs (− €10,035 [− €11,500; − €8570], p < 0.001).ConclusionLeft main stenting is a safe and effective treatment option for CCS-patients suffering from left main coronary artery disease at reasonable economic cost.Graphic abstractCoronary artery bypass grafting versus stent implantation in patients with chronic coronary syndrome and left main disease: insights from a register throughout Germany. All cases with chronic coronary syndrome and left main stenosis treated in 2018 in Germany either with left main stenting or coronary bypass grafting were extracted from a nation-wide database. In-hospital outcomes were compared after logistic regression analysis.
Highlights
About 5% of patients with chronic coronary syndrome (CCS) and 7% of patients with acute myocardial infarction suffer from left main disease [9]
Heart valve surgery were excluded. 87% of patients with chronic coronary syndrome and left main coronary artery disease were assigned to stent implantation (Fig. 1)
In 2018 almost 90% of patients with chronic coronary syndrome were assigned for left main stenting, indicating the importance of percutaneous coronary intervention (PCI) in the care of patients suffering from left main stenosis in clinical practice
Summary
About 5% of patients with chronic coronary syndrome (CCS) and 7% of patients with acute myocardial infarction suffer from left main disease [9]. In 1986 the first coronary stent was implanted This was a breakthrough for interventional cardiology, since it overcame the weakness of pure balloon angioplasty in particular in left main stenosis [7, 21]. Recent randomized controlled trials have sparked debate about the optimal treatment of patients suffering from left main coronary artery disease. The present study analyzes outcomes of left main stenting versus coronary bypass grafting (CABG) in a nationwide registry in patients with chronic coronary syndrome (CCS). Methods All cases suffering from CCS and left main coronary artery disease treated either with CABG or stent, were identified within the database of the German bureau of statistics. Conclusion Left main stenting is a safe and effective treatment option for CCS-patients suffering from left main coronary artery disease at reasonable economic cost
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