Original title: Long-Term Clinical Outcome Intervention Versus Coronary Artery Bypass Grafting for Ostial/Midshaft Lesion in Unprotected Left main Coronary Artery From The DELTA Registry. Reference: Toru Nagamuna et al. JACC Cardiovascular Intervention. Article in Press

Even though surgery remains the “gold standard” to treat UMCLA lesions, current guidelines have incorporated PCI as class IIa at ostium/midshaft level. The advantage of these segments is that they allow larger stent implantation without bifurcation compromise.

This registry analyzed 856 patients, 482 (56.3%) underwent left main PCI with first generation DES implantation and 374 (43.7%) revascularization surgery. Primary end point was a composite of all cause death, infarction and stroke and secondary end point added target vessel and target lesion revascularization.

The PCI group included younger, less hypertensive patients and fewer diabetics, but included more patients with renal failure and infarction episodes. PCI group showed lower SYNTAX scores and fewer multiple vessel and right coronary artery disease. Follow up at 1293 (989-1703) showed a 0.6% incidence of definite or probable thrombosis. 

The propensity score adjusted analysis showed no significant differences between the groups both at primary (HR 1.21, IC 95% 0.79 a 1.86; p=0.372) and secondary end points. There was a higher incidence of target vessel revascularization in the PCI group (HR 1.94, IC 95% 1.03 a 3.64; p=0.039). Age variable and Euroscore were both event predictors.

Conclusion

This study demonstrates that PCI for ostial/midshaft lesions in ULMCA is associated with clinical outcomes comparable to those observed with CABG, despite the use of first-generation DES. 

Comment

This study shows that PCI for ostial/midshaft lesions in ULMCA outcomes are comparable to those of surgery. This had already been showed in the MAIN COMPARE study. Although there were no significant differences at end points, PCI had higher angiography and revascularization rates. This could be due to the use of first generation DES and infrequent use of IVUS (33.4%).  However, PCI for ostial/midshaft lesions in ULMCA with DES implantation has been proved a viable strategy.

Courtesy of  Dr. Carlos Fava
Interventional Cardiologist
Favaloro Foundation
Buenos Aires – Argentina

Dr. Carlos Fava