Percutaneous coronary intervention vs. coronary artery bypass grafting in emergency and non-emergency unprotected left-main revascularization

Daoulah, Amin; Alqahtani, Abdulrahman H.; Elmahrouk, Ahmed; Yousif, Nooraldaem; Almahmeed, Wael; Arafat, Amr A.; Al Garni, Turki; Qutub, Mohammed A.; Dahdouh, Ziad; Alshehri, Mohammed; Hersi, Ahmad S.; Malak, Majed M.; Djunaedi, Syifa R.; Zaidi, Ayesha; Naser, Maryam Jameel; Qenawi, Wael; Elganady, Abdelmaksoud; Hassan, Taher; Ball, Vincent; Elmahrouk, Youssef; Hussien, Adnan Fathey; Alzahrani, Badr; Abuelatta, Reda; Selim, Ehab; Jamjoom, Ahmed; Alshali, Khalid Z.; Hashmani, Shahrukh; Refaat, Wael; Kazim, Hameedullah M.; Ghani, Mohamed Ajaz; Amin, Haitham; Ibrahim, Ahmed M.; Abohasan, Abdulwali; Alama, Mohamed N.; Balghith, Mohammed; Abdulhabeeb, Ibrahim A. M.; Ahmad, Osama; Ramadan, Mohamed; Ghonim, Ahmed A.; Shawky, Abeer M.; Noor, Husam A.; Alqahtani, Abdulrahman M.; Al Samadi, Faisal; Abualnaja, Seraj; Baqais, Rasha Taha; Alhassoun, Abdulkarim; Altnji, Issam; Khan, Mushira; Alasmari, Abdulaziz; Aljohar, Alwaleed; Hiremath, Niranjan; Aithal, Jairam; Lotfi, Amir

doi:10.1186/s40001-023-01189-1

Cited by 3 publications

(3 citation statements)

References 23 publications

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“…The primary outcomes were in-hospital and follow-up all-cause mortality (cardiac and noncardiac) and the composite endpoint of myocardial infarction (MI), congestive heart failure (CHF), target vessel and target lesion revascularization, and cerebrovascular events (major adverse cardiac and cerebrovascular events [MACCE]). Further details about the study population and definitions were previously published [12,13].…”

Section: Discussionmentioning

confidence: 99%

Left Main Coronary Artery Revascularization in Patients with Impaired Renal Function: Percutaneous Coronary Intervention versus Coronary Artery Bypass Grafting

Daoulah,

Taha Baqais,

Aljohar

et al. 2023

Kidney Blood Press Res

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Introduction: The evidence about the optimal revascularization strategy in patients with left-main coronary artery (LMCA) disease and impaired renal function is limited. Thus, we aimed to compare the outcomes of LMCA disease revascularization (PCI vs. CABG) in patients with and without impaired renal function. Methods: This retrospective cohort study included 2138 patients recruited from 14 centers between 2015 to 2019. We compared patients with impaired renal function who had PCI (n= 316) to those who had CABG (n= 121) and compared patients with normal renal function who had PCI (n= 906) to those who had CABG (n= 795). The study outcomes were in-hospital and follow-up major adverse cardiovascular and cerebrovascular events (MACCE). Results: Multivariable logistic regression analysis showed that the risk of in-hospital MACCE was significantly higher in CABG compared to PCI in patients with impaired renal function [OR: 8.13 (95% CI: 4.19- 15.76), P<0.001] and normal renal function [OR: 2.59 (95% CI: 1.79- 3.73); P<0.001]. There were no differences in follow-up MACCE between CABG and PCI in patients with impaired renal function [HR: 1.14 (95% CI: 0.71- 1.81), P= 0.585] and normal renal function [HR: 1.12 (0.90- 1.39), P= 0.312]. Conclusions: PCI could have an advantage over CABG in revascularization of LMCA disease in patients with impaired renal function regarding in-hospital MACCE. The follow-up MACCE was comparable between PCI and CABG in patients with impaired and normal renal function.

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Section: Discussionmentioning

confidence: 99%

Left Main Coronary Artery Revascularization in Patients with Impaired Renal Function: Percutaneous Coronary Intervention versus Coronary Artery Bypass Grafting

Daoulah,

Taha Baqais,

Aljohar

et al. 2023

Kidney Blood Press Res

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“…The Gulf Left Main Registry (G-LM) study includes a detailed report of the design, methods, selection and exclusion criteria, and the study endpoints [11]. G-LM is a retrospective, observational study that compared PCI and CABG in patients with ULMCA disease.…”

Section: Patient Datamentioning

confidence: 99%

“…We included patients with ULMCA disease treated with PCI (1,222) or CABG (916). The remaining 519 patients were excluded as detailed in the main report [11]. All PCIs were exclusively performed using second-generation drug-eluting stents across all centers.…”

Section: Patient Datamentioning

confidence: 99%

Outcomes of Left Main Revascularization in Patients with Anemia: Gulf Left Main Registry

Daoulah¹,

Naser²,

Hersi³

et al. 2023

Cardiology

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Introduction: Evaluate the effects of baseline anemia and anemia following revascularization on outcomes in patients with Unprotected Left Main Coronary Artery (ULMCA) disease. Methods: This was a retrospective, multicenter, observational study conducted between January 2015 to December 2019. The data on patients with ULMCA who underwent revascularization through PCI or CABG was stratified by hemoglobin level at baseline into anemic and non-anemic groups to compare in-hospital events. The pre-discharge hemoglobin following revascularization was categorized into very low (<80 g/L for men & women), low (≥80 & ≤119 g/L for women & ≤129 g/L for men) and normal (≥130 g/L for men & ≥120 g/L for women) to assess impact on follow-up outcomes. Results: A total of 2138 patients were included, 796 (37.2%) of which had anemia at baseline. A total of 319 developed anemia after revascularization and moved from being non-anemic at baseline to anemic at discharge. There was no difference in hospital MACE and mortality between CABG and PCI in anemic patients. At a median follow-up time of 20 months (IQR: 27), patients with pre-discharge anemia who underwent PCI had higher incidence of congestive heart failure (P< 0.0001), and those who underwent CABG had significantly higher follow-up mortality (HR: 9.85 (95% CI: 2.53- 38.43), P= 0.001). Discussion/Conclusion: In this Gulf LM study, baseline anemia had no impact upon in-hospital MACCE and total mortality following revascularization (PCI or CABG). However, pre-discharge anemia is associated with worse outcomes after unprotected LMCA disease revascularization, with significantly higher all-cause mortality in patients who had CABG, and higher incidence of CHF in PCI patients, at a median follow-up time of 20 months (IQR: 27).

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Single Versus Dual Antiplatelet Therapy After Coronary Artery Bypass Grafting for Unprotected Left-Main Coronary Disease

Daoulah,

Qenawi,

Alshehri

et al. 2023

Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine

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Background: The use of dual antiplatelet therapy (DAPT) after coronary revascularization for left-main disease is still debated. The study aimed to characterize patients who received dual versus single antiplatelet therapy (SAPT) after coronary artery bypass grafting (CABG) for unprotected left-main disease and compare the outcomes of those patients. Results: This multicenter retrospective cohort study included 551 patients who were grouped into 2 groups: patients who received SAPT (n = 150) and those who received DAPT (n = 401). There were no differences in age (P = 0.451), gender (P = 0.063), smoking (P = 0.941), diabetes mellitus (P = 0.773), history of myocardial infarction (P = 0.709), chronic kidney disease (P = 0.615), atrial fibrillation (P = 0.306), or cerebrovascular accident (P = 0.550) between patients who received SAPT versus DAPT. DAPTs were more commonly used in patients with acute coronary syndrome [87 (58%) vs. 273 (68.08%); P = 0.027], after off-pump CABG [12 (8%) vs. 73 (18.2%); P = 0.003] and in patients with radial artery grafts [1 (0.67%) vs. 32 (7.98%); P < 0.001]. While SAPTs were more commonly used in patients with low ejection fraction [55 (36.67%) vs. 61 (15.21%); P < 0.001] and in patients with postoperative acute kidney injury [27 (18%) vs. 37 (9.23%); P = 0.004]. The attributed treatment effect of DAPT for follow-up major adverse cerebrovascular and cardiac events was not significantly different from that of SAPT [β, −2.08 (95% confidence interval (CI), −20.8–16.7); P = 0.828]. The attributed treatment effect of DAPT on follow-up all-cause mortality was not significantly different from that of SAPT [β, 4.12 (CI, −11.1–19.32); P = 0.595]. There was no difference in bleeding between groups (P = 0.666). Conclusions: DAPTs were more commonly used in patients with acute coronary syndrome, after off-pump CABG, and with radial artery grafts. SAPTs were more commonly used in patients with low ejection fraction and acute kidney injury. Patients on DAPT after CABG for left-main disease had comparable major adverse cerebrovascular and cardiac events and survival to patients on SAPT, with no difference in bleeding events.

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Percutaneous coronary intervention vs. coronary artery bypass grafting in emergency and non-emergency unprotected left-main revascularization

Cited by 3 publications

References 23 publications

Left Main Coronary Artery Revascularization in Patients with Impaired Renal Function: Percutaneous Coronary Intervention versus Coronary Artery Bypass Grafting

Left Main Coronary Artery Revascularization in Patients with Impaired Renal Function: Percutaneous Coronary Intervention versus Coronary Artery Bypass Grafting

Outcomes of Left Main Revascularization in Patients with Anemia: Gulf Left Main Registry

Single Versus Dual Antiplatelet Therapy After Coronary Artery Bypass Grafting for Unprotected Left-Main Coronary Disease

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