Drug-Eluting Stent for Left Main Coronary Artery Disease The DELTA Registry: A Multicenter Registry Evaluating Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting for Left Main Treatment

被引：109

作者：

Chieffo, Alaide ^{[1
]}

Meliga, Emanuele ^{[2
]}

Latib, Azeem ^{[1
]}

Park, Seung-Jung ^{[3
]}

Onuma, Yoshinobu ^{[4
]}

Capranzano, Piera ^{[5
]}

Valgimigli, Marco ^{[6
]}

Jegere, Sanda ^{[7
,8
]}

Makkar, Raj R. ^{[9
]}

Palacios, Igor F. ^{[10
,11
]}

Kim, Young-Hak ^{[3
]}

Buszman, Pawel E. ^{[12
]}

Chakravarty, Tarun ^{[9
]}

Sheiban, Imad ^{[13
]}

Mehran, Roxana ^{[14
]}

Naber, Christoph ^{[17
]}

Margey, Ronan ^{[10
,11
]}

Agnihotri, Arvind ^{[10
,11
]}

Marra, Sebastiano ^{[13
]}

Capodanno, Davide ^{[5
]}

Leon, Martin B. ^{[15
,16
]}

Moses, Jeffrey W. ^{[15
,16
]}

Fajadet, Jean ^{[17
]}

Lefevre, Thierry ^{[18
]}

Morice, Marie-Claude ^{[18
]}

Erglis, Andrejs ^{[7
,8
]}

Tamburino, Corrado ^{[5
]}

Alfieri, Ottavio ^{[1
]}

Serruys, Patrick W. ^{[4
]}

Colombo, Antonio ^{[1
]}

机构：

[1] Ist Sci San Raffaele, Dept Cardiothorac & Vasc Dis, I-0132 Milan, Italy

[2] AO Ordine Mauriziano Umberto I, Intervent Cardiol Unit, Turin, Italy

[3] Univ Ulsan, Coll Med, Asan Med Ctr, Dept Cardiol,Ctr Med Res & Informat, Seoul, South Korea

[4] Erasmus MC, Thoraxctr, Rotterdam, Netherlands

[5] Univ Catania, Ferrarotto Hosp, Catania, Italy

[6] Univ Ferrara, S Anna Hosp, Cardiovasc Inst, I-44100 Ferrara, Italy

[7] Pauls Stradins Clin Univ Hosp, Latvian Ctr Cardiol, Riga, Latvia

[8] Univ Latvia, Inst Cardiol, Riga, Latvia

[9] Cedars Sinai Med Ctr, Cedars Sinai Heart Inst, Los Angeles, CA 90048 USA

[10] Massachusetts Gen Hosp, Cardiac Catheterizat Lab, Boston, MA 02114 USA

[11] Harvard Univ, Sch Med, Boston, MA USA

[12] Amer Heart Poland Inc, Katowice, Poland

[13] Univ Turin, Div Cardiol, S Giovanni Battista Molinette Hosp, Turin, Italy

[14] Mt Sinai Med Ctr, New York, NY 10029 USA

[15] Columbia Univ, Med Ctr, New York, NY USA

[16] Cardiovasc Res Fdn, New York, NY USA

[17] Clin Pasteur, Toulouse, France

[18] Inst Hosp Jacques Cartier, Massy, France

来源：

JACC-CARDIOVASCULAR INTERVENTIONS | 2012年 / 5卷 / 07期

关键词：

coronary artery bypass graft; drug-eluting stent; left main coronary artery disease; percutaneous coronary intervention; UNPROTECTED LEFT MAIN; BARE-METAL STENTS; SURGICAL REVASCULARIZATION; STENOSIS; IMPLANTATION; OUTCOMES; SURGERY; EXPERIENCE; CARDIOLOGY;

D O I：

10.1016/j.jcin.2012.03.022

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objectives The aim of this study was to compare, in a large all-comers registry, major adverse cardiac and cerebrovascular events (MACCE) after percutaneous coronary intervention (PCI) with first-generation drug-eluting stents (DES) versus coronary artery bypass grafting (CABG) in unprotected left main coronary artery (ULMCA) stenosis. Background Percutaneous coronary intervention with DES implantation in ULMCA has been shown to be a feasible and safe approach at midterm clinical follow-up. Methods All consecutive patients with ULMCA stenosis treated by PCI with DES versus CABG were analyzed in this multinational registry. A propensity score analysis was performed to adjust for baseline differences in the overall cohort. Results In total 2,775 patients were included: 1,874 were treated with PCI versus 901 with CABG. At 1,295 (interquartile range: 928 to 1,713) days, there were no differences, at the adjusted analysis, in the primary composite endpoint of death, cerebrovascular accidents, and myocardial infarction (MI) (adjusted hazard ratio [HR]: 1.11; 95% confidence interval [CI]: 0.85 to 1.42; p = 0.47), mortality (adjusted HR: 1.16; 95% CI: 0.87 to 1.55; p = 0.32), or composite endpoint of death and MI (adjusted HR: 1.25; 95% CI: 0.95 to 1.64; p = 0.11). An advantage of CABG over PCI was observed in the composite secondary endpoint of MACCE (adjusted HR: 1.64; 95% CI: 1.33 to 2.03; p < 0.0001), driven exclusively by the higher incidence of target vessel revascularization with PCI. Conclusions In our multinational all-comers registry, no difference was observed in the occurrence of death, cerebrovascular accidents, and MI between PCI and CABG. An advantage of CABG over PCI was observed in the incidence of MACCE, driven by the higher incidence of target vessel revascularization with PCI. (J Am Coll Cardiol Intv 2012;5:718-27) (C) 2012 by the American College of Cardiology Foundation

引用

页码：718 / 727

页数：10

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