Department of Cardiology and Angiology I, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Center of Big Data Analysis in Cardiology (CeBAC), Department of Cardiology and Angiology I, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Clin Res Cardiol. 2022 Jul;111(7):742-749. doi: 10.1007/s00392-021-01931-x. Epub 2021 Aug 28.
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).
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. Logistic or linear regression models were used with 20 baseline patient characteristics as potential confounders to compare both regimens.
In 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).
Left main stenting is a safe and effective treatment option for CCS-patients suffering from left main coronary artery disease at reasonable economic cost. Coronary 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.
最近的随机对照试验引发了关于左主干冠状动脉疾病患者最佳治疗方法的争论。本研究分析了在全国范围内慢性冠状动脉综合征（CCS）患者中左主干支架置入与冠状动脉旁路移植术（CABG）的结果。
在德国统计局的数据库中确定了所有接受 CABG 或支架治疗的慢性冠状动脉综合征合并左主干冠状动脉疾病的患者。使用逻辑或线性回归模型，以 20 个基线患者特征作为潜在混杂因素，比较两种方案。
2018 年，1318 例左主干狭窄患者接受 CABG 治疗，8920 例接受支架治疗。接受支架治疗的患者年龄较大（72.58±9.87 vs. 68.63±9.40，p<0.001），手术风险较高，采用逻辑欧洲心脏手术风险评分（8.77±8.45 vs. 4.85±4.65，p<0.001）评估。风险调整后，住院死亡率和卒中无明显差异（支架替代 CABG 的风险调整比值比[aOR]：aOR 死亡率：1.08[95%CI 0.66;1.78]，p=0.748；aOR 卒中：0.59[0.27;1.32]，p=0.199）。支架植入与相关出血风险降低相关（aOR 0.38[0.24;0.61]，p<0.001）、延长通气时间减少（aOR 0.54[0.37 0.79]，p=0.002）和术后谵妄减少（aOR 0.16[0.11;0.22]，p<0.001）。此外，支架植入与住院时间缩短（-6.78 天[-5.86；-7.71]，p<0.001）和成本降低（-€10035[-€11500；-€8570]，p<0.001）相关。
对于患有左主干冠状动脉疾病的慢性冠状动脉综合征患者，左主干支架置入术是一种安全有效的治疗选择，具有合理的经济成本。慢性冠状动脉综合征和左主干疾病患者的冠状动脉旁路移植术与支架植入术：来自德国全国范围内的登记数据。从德国全国范围内的数据库中提取了 2018 年接受左主干支架置入术或冠状动脉旁路移植术治疗的所有慢性冠状动脉综合征合并左主干狭窄的患者。对逻辑回归分析后的住院期间结局进行了比较。
