Open AccessSecond Generation Drug-Eluting Stent Implantation versus Coronary Artery Bypass Grafting in the Treatment of Young Patients with Left Main and/or Multivessel Coronary Disease
Author(s) -
Xue Chen,
Xuehui Zhang,
Yunfeng Yan,
Xin Zhao,
Maoxiao Nie,
Tingting Feng,
Zhe Liang,
Qiong Zhao
Publication year - 2020
Publication title -
journal of interventional cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.764
H-Index - 51
eISSN - 1540-8183
pISSN - 0896-4327
DOI - 10.1155/2020/6736704
Subject(s) - medicine , conventional pci , percutaneous coronary intervention , cardiology , hazard ratio , myocardial infarction , coronary artery disease , revascularization , propensity score matching , stent , drug eluting stent , clinical endpoint , stroke (engine) , proportional hazards model , confidence interval , surgery , randomized controlled trial , mechanical engineering , engineering
Background Many studies have compared the outcomes of coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) for complex coronary artery disease (CAD). However, no trials have focused on young patients (<45 years) with complex CAD. We conducted a retrospective evaluation to compare the outcomes of a second-generation drug-eluting stent (DES) and CABG in young patients with LM or three-vessel disease.Methods In young patients with complex CAD who underwent PCI or CABG, a Kaplan-Meier analysis and Cox regression before and after propensity score matching were used to compare major adverse cardiac and cerebrovascular events (MACCE), including myocardial infarction (MI), stroke, death, and repeat revascularization.Results During follow-up, MACCE occurred in 20.5% of patients in the PCI group and 8.6% of patients in the CABG group (hazard ratio (HR): 3.263, 95% confidence interval (CI): 1.379 to 7.722, p =0.007). Repeat revascularization occurred more frequently in the PCI group (18.9% vs. 3.7%, respectively, HR: 6.968, 95% CI: 2.036 to 23.842, p =0.002). There were no significant differences in the other endpoints. After propensity score matching, no conclusions were modified.Conclusions In young patients with LM or three-vessel disease, PCI showed a higher incidence of MACCE, which was mainly driven by repeat revascularization. However, this did not translate into hard endpoint differences. Therefore, PCI is an alternative treatment to CABG in young patients with complex CAD.