Percutaneous Coronary Intervention vs. Coronary Artery Bypass Grafting for Treating In-Stent Restenosis in Unprotected-Left Main: LM-DRAGON-Registry

Wojciech Wańha; Jacek Bil; Michalina Kołodziejczak; Adam Kowalówka; Mariusz Kowalewski; Damian Hudziak; Radosław Gocoł; Rafał Januszek; Tomasz Figatowski; Marek Milewski; Brunon Tomasiewicz; Piotr Kübler; Bruno Hrymniak; Piotr Desperak; Łukasz Kuźma; Krzysztof Milewski; Bartłomiej Góra; Andrzej Łoś; Jan Kulczycki; Adrian Włodarczak; Wojciech Skorupski; Marek Grygier; Maciej Lesiak; Fabrizio D'Ascenzo; Marek Andres; Paweł Kleczynski; Radosław Litwinowicz; Andrea Borin; Grzegorz Smolka; Krzysztof Reczuch; Marcin Gruchała; Robert J Gil; Miłosz Jaguszewski; Krzysztof Bartuś; Piotr Suwalski; Sławomir Dobrzycki; Dariusz Dudek; Stanisław Bartuś; Mariusz Ga Sior; Andrzej Ochała; Alexandra J Lansky; Marek Deja; Jacek Legutko; Elvin Kedhi; Wojciech Wojakowski

doi:10.3389/fcvm.2022.849971

Percutaneous Coronary Intervention vs. Coronary Artery Bypass Grafting for Treating In-Stent Restenosis in Unprotected-Left Main: LM-DRAGON-Registry

Wojciech Wańha^*, Jacek Bil, Michalina Kołodziejczak, Adam Kowalówka, Mariusz Kowalewski, Damian Hudziak, Radosław Gocoł, Rafał Januszek, Tomasz Figatowski, Marek Milewski, Brunon Tomasiewicz, Piotr Kübler, Bruno Hrymniak, Piotr Desperak, Łukasz Kuźma, Krzysztof Milewski, Bartłomiej Góra, Andrzej Łoś, Jan Kulczycki, Adrian WłodarczakWojciech Skorupski, Marek Grygier, Maciej Lesiak, Fabrizio D'Ascenzo, Marek Andres, Paweł Kleczynski, Radosław Litwinowicz, Andrea Borin, Grzegorz Smolka, Krzysztof Reczuch, Marcin Gruchała, Robert J Gil, Miłosz Jaguszewski, Krzysztof Bartuś, Piotr Suwalski, Sławomir Dobrzycki, Dariusz Dudek, Stanisław Bartuś, Mariusz Ga Sior, Andrzej Ochała, Alexandra J Lansky, Marek Deja, Jacek Legutko, Elvin Kedhi, Wojciech Wojakowski

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Background: Data regarding management of patients with unprotected left main coronary artery in-stent restenosis (LM-ISR) are scarce.

Objectives: This study investigated the safety and effectiveness of percutaneous coronary intervention (PCI) vs. coronary artery bypass grafting (CABG) for the treatment of unprotected LM-ISR.

Methods: Consecutive patients who underwent PCI or CABG for unprotected LM-ISR were enrolled. The primary endpoint was a composite of major adverse cardiac and cerebrovascular events (MACCE), defined as cardiac death, myocardial infarction (MI), target vessel revascularization (TVR), and stroke.

Results: A total of 305 patients were enrolled, of which 203(66.6%) underwent PCI and 102(33.4%) underwent CABG. At 30-day follow-up, a lower risk of cardiac death was observed in the PCI group, compared with the CABG-treated group (2.1% vs. 7.1%, HR 3.48, 95%CI 1.01-11.8, p = 0.04). At a median of 3.5 years [interquartile range (IQR) 1.3-5.5] follow-up, MACCE occurred in 27.7% vs. 29.6% (HR 0.82, 95%CI 0.52-1.32, p = 0.43) in PCI- and CABG-treated patients, respectively. There were no significant differences between PCI and CABG in cardiac death (9.9% vs. 18.4%; HR 1.56, 95%CI 0.81-3.00, p = 0.18), MI (7.9% vs. 5.1%, HR 0.44, 95%CI 0.15-1.27, p = 0.13), or stroke (2.1% vs. 4.1%, HR 1.79, 95%CI 0.45-7.16, p = 0.41). TVR was more frequently needed in the PCI group (15.2% vs. 6.1%, HR 0.35, 95%CI 0.15-0.85, p = 0.02).

Conclusions: This analysis of patients with LM-ISR revealed a lower incidence of cardiac death in PCI compared with CABG in short-term follow-up. During the long-term follow-up, no differences in MACCE were observed, but patients treated with CABG less often required TVR.

Visual overview: A visual overview is available for this article.

Registration: https://www.clinicaltrials.gov; Unique identifier: NCT04968977.

Original language	English
Article number	849971
Number of pages	9
Journal	Frontiers in Cardiovascular Medicine
Volume	9
DOIs	https://doi.org/10.3389/fcvm.2022.849971
Publication status	Published - 29 Apr 2022

Keywords

CLASSIFICATION
DISEASE
DRUG-ELUTING STENTS
FAILURE
IMPACT
IMPLANTATION
LESIONS
LONG-TERM MORTALITY
MANAGEMENT
OUTCOMES
coronary artery bypass graft (CABG)
in-stent restenosis (ISR)
left main
percutaneous coronary intervention (complex PCI)
stents (Coronary)

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Wańha, W., Bil, J., Kołodziejczak, M., Kowalówka, A., Kowalewski, M., Hudziak, D., Gocoł, R., Januszek, R., Figatowski, T., Milewski, M., Tomasiewicz, B., Kübler, P., Hrymniak, B., Desperak, P., Kuźma, Ł., Milewski, K., Góra, B., Łoś, A., Kulczycki, J., ... Wojakowski, W. (2022). Percutaneous Coronary Intervention vs. Coronary Artery Bypass Grafting for Treating In-Stent Restenosis in Unprotected-Left Main: LM-DRAGON-Registry. Frontiers in Cardiovascular Medicine, 9, Article 849971. https://doi.org/10.3389/fcvm.2022.849971

@article{2c4a74c44fce452a92e0b478990fe1da,

title = "Percutaneous Coronary Intervention vs. Coronary Artery Bypass Grafting for Treating In-Stent Restenosis in Unprotected-Left Main: LM-DRAGON-Registry",

abstract = "Background: Data regarding management of patients with unprotected left main coronary artery in-stent restenosis (LM-ISR) are scarce.Objectives: This study investigated the safety and effectiveness of percutaneous coronary intervention (PCI) vs. coronary artery bypass grafting (CABG) for the treatment of unprotected LM-ISR.Methods: Consecutive patients who underwent PCI or CABG for unprotected LM-ISR were enrolled. The primary endpoint was a composite of major adverse cardiac and cerebrovascular events (MACCE), defined as cardiac death, myocardial infarction (MI), target vessel revascularization (TVR), and stroke.Results: A total of 305 patients were enrolled, of which 203(66.6%) underwent PCI and 102(33.4%) underwent CABG. At 30-day follow-up, a lower risk of cardiac death was observed in the PCI group, compared with the CABG-treated group (2.1% vs. 7.1%, HR 3.48, 95%CI 1.01-11.8, p = 0.04). At a median of 3.5 years [interquartile range (IQR) 1.3-5.5] follow-up, MACCE occurred in 27.7% vs. 29.6% (HR 0.82, 95%CI 0.52-1.32, p = 0.43) in PCI- and CABG-treated patients, respectively. There were no significant differences between PCI and CABG in cardiac death (9.9% vs. 18.4%; HR 1.56, 95%CI 0.81-3.00, p = 0.18), MI (7.9% vs. 5.1%, HR 0.44, 95%CI 0.15-1.27, p = 0.13), or stroke (2.1% vs. 4.1%, HR 1.79, 95%CI 0.45-7.16, p = 0.41). TVR was more frequently needed in the PCI group (15.2% vs. 6.1%, HR 0.35, 95%CI 0.15-0.85, p = 0.02).Conclusions: This analysis of patients with LM-ISR revealed a lower incidence of cardiac death in PCI compared with CABG in short-term follow-up. During the long-term follow-up, no differences in MACCE were observed, but patients treated with CABG less often required TVR.Visual overview: A visual overview is available for this article.Registration: https://www.clinicaltrials.gov; Unique identifier: NCT04968977.",

keywords = "CLASSIFICATION, DISEASE, DRUG-ELUTING STENTS, FAILURE, IMPACT, IMPLANTATION, LESIONS, LONG-TERM MORTALITY, MANAGEMENT, OUTCOMES, coronary artery bypass graft (CABG), in-stent restenosis (ISR), left main, percutaneous coronary intervention (complex PCI), stents (Coronary)",

author = "Wojciech Wa{\'n}ha and Jacek Bil and Michalina Ko{\l}odziejczak and Adam Kowal{\'o}wka and Mariusz Kowalewski and Damian Hudziak and Rados{\l}aw Goco{\l} and Rafa{\l} Januszek and Tomasz Figatowski and Marek Milewski and Brunon Tomasiewicz and Piotr K{\"u}bler and Bruno Hrymniak and Piotr Desperak and {\L}ukasz Ku{\'z}ma and Krzysztof Milewski and Bart{\l}omiej G{\'o}ra and Andrzej {\L}o{\'s} and Jan Kulczycki and Adrian W{\l}odarczak and Wojciech Skorupski and Marek Grygier and Maciej Lesiak and Fabrizio D'Ascenzo and Marek Andres and Pawe{\l} Kleczynski and Rados{\l}aw Litwinowicz and Andrea Borin and Grzegorz Smolka and Krzysztof Reczuch and Marcin Grucha{\l}a and Gil, {Robert J} and Mi{\l}osz Jaguszewski and Krzysztof Bartu{\'s} and Piotr Suwalski and S{\l}awomir Dobrzycki and Dariusz Dudek and Stanis{\l}aw Bartu{\'s} and {Ga Sior}, Mariusz and Andrzej Ocha{\l}a and Lansky, {Alexandra J} and Marek Deja and Jacek Legutko and Elvin Kedhi and Wojciech Wojakowski",

note = "Copyright {\textcopyright} 2022 Wa{\'n}ha, Bil, Ko{\l}odziejczak, Kowal{\'o}wka, Kowalewski, Hudziak, Goco{\l}, Januszek, Figatowski, Milewski, Tomasiewicz, K{\"u}bler, Hrymniak, Desperak, Ku{\'z}ma, Milewski, G{\'o}ra, {\L}o{\'s}, Kulczycki, W{\l}odarczak, Skorupski, Grygier, Lesiak, D'Ascenzo, Andres, Kleczynski, Litwinowicz, Borin, Smolka, Reczuch, Grucha{\l}a, Gil, Jaguszewski, Bartu{\'s}, Suwalski, Dobrzycki, Dudek, Bartu{\'s}, G{\c a}sior, Ocha{\l}a, Lansky, Deja, Legutko, Kedhi and Wojakowski.",

year = "2022",

month = apr,

day = "29",

doi = "10.3389/fcvm.2022.849971",

language = "English",

volume = "9",

journal = "Frontiers in Cardiovascular Medicine",

issn = "2297-055X",

publisher = "Frontiers Media S.A.",

}

Wańha, W, Bil, J, Kołodziejczak, M, Kowalówka, A, Kowalewski, M, Hudziak, D, Gocoł, R, Januszek, R, Figatowski, T, Milewski, M, Tomasiewicz, B, Kübler, P, Hrymniak, B, Desperak, P, Kuźma, Ł, Milewski, K, Góra, B, Łoś, A, Kulczycki, J, Włodarczak, A, Skorupski, W, Grygier, M, Lesiak, M, D'Ascenzo, F, Andres, M, Kleczynski, P, Litwinowicz, R, Borin, A, Smolka, G, Reczuch, K, Gruchała, M, Gil, RJ, Jaguszewski, M, Bartuś, K, Suwalski, P, Dobrzycki, S, Dudek, D, Bartuś, S, Ga Sior, M, Ochała, A, Lansky, AJ, Deja, M, Legutko, J, Kedhi, E & Wojakowski, W 2022, 'Percutaneous Coronary Intervention vs. Coronary Artery Bypass Grafting for Treating In-Stent Restenosis in Unprotected-Left Main: LM-DRAGON-Registry', Frontiers in Cardiovascular Medicine, vol. 9, 849971. https://doi.org/10.3389/fcvm.2022.849971

TY - JOUR

T1 - Percutaneous Coronary Intervention vs. Coronary Artery Bypass Grafting for Treating In-Stent Restenosis in Unprotected-Left Main

T2 - LM-DRAGON-Registry

AU - Wańha, Wojciech

AU - Bil, Jacek

AU - Kołodziejczak, Michalina

AU - Kowalówka, Adam

AU - Kowalewski, Mariusz

AU - Hudziak, Damian

AU - Gocoł, Radosław

AU - Januszek, Rafał

AU - Figatowski, Tomasz

AU - Milewski, Marek

AU - Tomasiewicz, Brunon

AU - Kübler, Piotr

AU - Hrymniak, Bruno

AU - Desperak, Piotr

AU - Kuźma, Łukasz

AU - Milewski, Krzysztof

AU - Góra, Bartłomiej

AU - Łoś, Andrzej

AU - Kulczycki, Jan

AU - Włodarczak, Adrian

AU - Skorupski, Wojciech

AU - Grygier, Marek

AU - Lesiak, Maciej

AU - D'Ascenzo, Fabrizio

AU - Andres, Marek

AU - Kleczynski, Paweł

AU - Litwinowicz, Radosław

AU - Borin, Andrea

AU - Smolka, Grzegorz

AU - Reczuch, Krzysztof

AU - Gruchała, Marcin

AU - Gil, Robert J

AU - Jaguszewski, Miłosz

AU - Bartuś, Krzysztof

AU - Suwalski, Piotr

AU - Dobrzycki, Sławomir

AU - Dudek, Dariusz

AU - Bartuś, Stanisław

AU - Ga Sior, Mariusz

AU - Ochała, Andrzej

AU - Lansky, Alexandra J

AU - Deja, Marek

AU - Legutko, Jacek

AU - Kedhi, Elvin

AU - Wojakowski, Wojciech

N1 - Copyright © 2022 Wańha, Bil, Kołodziejczak, Kowalówka, Kowalewski, Hudziak, Gocoł, Januszek, Figatowski, Milewski, Tomasiewicz, Kübler, Hrymniak, Desperak, Kuźma, Milewski, Góra, Łoś, Kulczycki, Włodarczak, Skorupski, Grygier, Lesiak, D'Ascenzo, Andres, Kleczynski, Litwinowicz, Borin, Smolka, Reczuch, Gruchała, Gil, Jaguszewski, Bartuś, Suwalski, Dobrzycki, Dudek, Bartuś, Ga̧sior, Ochała, Lansky, Deja, Legutko, Kedhi and Wojakowski.

PY - 2022/4/29

Y1 - 2022/4/29

N2 - Background: Data regarding management of patients with unprotected left main coronary artery in-stent restenosis (LM-ISR) are scarce.Objectives: This study investigated the safety and effectiveness of percutaneous coronary intervention (PCI) vs. coronary artery bypass grafting (CABG) for the treatment of unprotected LM-ISR.Methods: Consecutive patients who underwent PCI or CABG for unprotected LM-ISR were enrolled. The primary endpoint was a composite of major adverse cardiac and cerebrovascular events (MACCE), defined as cardiac death, myocardial infarction (MI), target vessel revascularization (TVR), and stroke.Results: A total of 305 patients were enrolled, of which 203(66.6%) underwent PCI and 102(33.4%) underwent CABG. At 30-day follow-up, a lower risk of cardiac death was observed in the PCI group, compared with the CABG-treated group (2.1% vs. 7.1%, HR 3.48, 95%CI 1.01-11.8, p = 0.04). At a median of 3.5 years [interquartile range (IQR) 1.3-5.5] follow-up, MACCE occurred in 27.7% vs. 29.6% (HR 0.82, 95%CI 0.52-1.32, p = 0.43) in PCI- and CABG-treated patients, respectively. There were no significant differences between PCI and CABG in cardiac death (9.9% vs. 18.4%; HR 1.56, 95%CI 0.81-3.00, p = 0.18), MI (7.9% vs. 5.1%, HR 0.44, 95%CI 0.15-1.27, p = 0.13), or stroke (2.1% vs. 4.1%, HR 1.79, 95%CI 0.45-7.16, p = 0.41). TVR was more frequently needed in the PCI group (15.2% vs. 6.1%, HR 0.35, 95%CI 0.15-0.85, p = 0.02).Conclusions: This analysis of patients with LM-ISR revealed a lower incidence of cardiac death in PCI compared with CABG in short-term follow-up. During the long-term follow-up, no differences in MACCE were observed, but patients treated with CABG less often required TVR.Visual overview: A visual overview is available for this article.Registration: https://www.clinicaltrials.gov; Unique identifier: NCT04968977.

AB - Background: Data regarding management of patients with unprotected left main coronary artery in-stent restenosis (LM-ISR) are scarce.Objectives: This study investigated the safety and effectiveness of percutaneous coronary intervention (PCI) vs. coronary artery bypass grafting (CABG) for the treatment of unprotected LM-ISR.Methods: Consecutive patients who underwent PCI or CABG for unprotected LM-ISR were enrolled. The primary endpoint was a composite of major adverse cardiac and cerebrovascular events (MACCE), defined as cardiac death, myocardial infarction (MI), target vessel revascularization (TVR), and stroke.Results: A total of 305 patients were enrolled, of which 203(66.6%) underwent PCI and 102(33.4%) underwent CABG. At 30-day follow-up, a lower risk of cardiac death was observed in the PCI group, compared with the CABG-treated group (2.1% vs. 7.1%, HR 3.48, 95%CI 1.01-11.8, p = 0.04). At a median of 3.5 years [interquartile range (IQR) 1.3-5.5] follow-up, MACCE occurred in 27.7% vs. 29.6% (HR 0.82, 95%CI 0.52-1.32, p = 0.43) in PCI- and CABG-treated patients, respectively. There were no significant differences between PCI and CABG in cardiac death (9.9% vs. 18.4%; HR 1.56, 95%CI 0.81-3.00, p = 0.18), MI (7.9% vs. 5.1%, HR 0.44, 95%CI 0.15-1.27, p = 0.13), or stroke (2.1% vs. 4.1%, HR 1.79, 95%CI 0.45-7.16, p = 0.41). TVR was more frequently needed in the PCI group (15.2% vs. 6.1%, HR 0.35, 95%CI 0.15-0.85, p = 0.02).Conclusions: This analysis of patients with LM-ISR revealed a lower incidence of cardiac death in PCI compared with CABG in short-term follow-up. During the long-term follow-up, no differences in MACCE were observed, but patients treated with CABG less often required TVR.Visual overview: A visual overview is available for this article.Registration: https://www.clinicaltrials.gov; Unique identifier: NCT04968977.

KW - CLASSIFICATION

KW - DISEASE

KW - DRUG-ELUTING STENTS

KW - FAILURE

KW - IMPACT

KW - IMPLANTATION

KW - LESIONS

KW - LONG-TERM MORTALITY

KW - MANAGEMENT

KW - OUTCOMES

KW - coronary artery bypass graft (CABG)

KW - in-stent restenosis (ISR)

KW - left main

KW - percutaneous coronary intervention (complex PCI)

KW - stents (Coronary)

U2 - 10.3389/fcvm.2022.849971

DO - 10.3389/fcvm.2022.849971

M3 - Article

C2 - 35615559

SN - 2297-055X

VL - 9

JO - Frontiers in Cardiovascular Medicine

JF - Frontiers in Cardiovascular Medicine

M1 - 849971

ER -

Percutaneous Coronary Intervention vs. Coronary Artery Bypass Grafting for Treating In-Stent Restenosis in Unprotected-Left Main: LM-DRAGON-Registry

Abstract

Keywords

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