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Bonaros N, Ruttmann E, Grimm M. Is the left main still the main issue in coronary surgery? Eur J Cardiothorac Surg 2022; 62:6696714. [PMID: 36099029 DOI: 10.1093/ejcts/ezac461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 09/12/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Nikolaos Bonaros
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Elfriede Ruttmann
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Grimm
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
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Caliskan E, Misfeld M, Sandner S, Böning A, Aramendi J, Salzberg SP, Choi YH, Perrault LP, Tekin I, Cuerpo GP, Lopez-Menendez J, Weltert LP, Böhm J, Krane M, González-Santos JM, Tellez JC, Holubec T, Ferrari E, Emmert MY. Clinical event rate in patients with and without left main disease undergoing isolated CABG: results from the European DuraGraft registry. Eur J Cardiothorac Surg 2022; 62:6656349. [PMID: 35929787 DOI: 10.1093/ejcts/ezac403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 07/25/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Left main coronary artery disease (LMCAD) is considered an independent risk factor for clinical events after coronary artery bypass grafting (CABG). We have conducted a subgroup analysis of the multicentre European DuraGraft registry to investigate clinical event-rates at 1-year in patients with and without LMCAD undergoing isolated CABG in contemporary practice. METHODS Patients undergoing isolated CABG were selected. The primary end-point was the incidence of a major adverse cardiac event (MACE) defined as the composite of death, myocardial infarction (MI) or repeat revascularization (RR) at 1-year. The secondary end-point was major adverse cardiac and cerebrovascular events (MACCE) defined as MACE plus stroke. Propensity score matching (PSM) was performed to balance for differences in baseline characteristics. RESULTS LMCAD was present in 1,033 (41.2%) and absent in 1,477 (58.8%) patients. At 1-year, the MACE rate was higher for LMCAD patients (8.2% vs 5.1%, p = 0.002) driven by higher rates of death (5.4% vs 3.4%, p = 0.016), MI (3.0% vs 1.3%, p = 0.002) and numerically higher rates of RR (2.8% vs 1.8%, p = 0.13). The incidence of MACCE was 8.8% vs 6.6%, p = 0.043 with a stroke rate of 1.0% and 2.4%, p = 0.011, for LMCAD and non-LMCAD group, respectively. After PSM, the MACE rate was 8.0% vs 5.2%, p = 0.015. The incidence of death was 5.1% vs 3.7%, p = 0.10, MI 3.0% vs 1.4%, p = 0.020, and RR was 2.7% vs 1.6%, p = 0.090, for the LMCAD and non-LMCAD group, respectively. Less strokes occurred in LMCAD patients (1.0% vs 2.4%, p = 0.017). The MACCE rate was not different: 8.5% vs 6.7%, p = 0.12. CONCLUSIONS In this large registry, LMCAD was demonstrated to be an independent risk factor for MACE after isolated CABG. Conversely, the risk of stroke was lower in LMCAD patients. TRIAL REGISTRATION ClinicalTrials.gov NCT02922088.
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Affiliation(s)
- Etem Caliskan
- Charité Universitätsmedizin Berlin, Berlin, Germany.,German Heart Center Berlin, Berlin, Germany
| | - Martin Misfeld
- Leipzig Heart Center, Leipzig, Germany.,Royal Prince Alfred Hospital, Sydney, Australia.,Institute of Academic Surgery at RPA, Sydney, Australia.,The Baird Institute of Applied Heart and Lung Surgical Research, Sydney, Australia.,Medical School, University of Sydney, Australia
| | - Sigrid Sandner
- Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Andreas Böning
- Universitätsklinikum Gießen und Marburg GmbH, Gießen, Germany
| | | | | | - Yeong-Hoon Choi
- Kerckhoff Heart Center Bad Nauheim, Campus Kerckhoff Justus-Liebig University Giessen
| | | | - Ilker Tekin
- Manavgat Government Hospital, Manavgat, Turkey.,Bahçeşehir University Faculty of Medicine, İstanbul, Turkey
| | | | | | | | | | - Markus Krane
- German Heart Center Munich, Munich, Germany.,Yale University School of Medicine, New Haven, Connecticut, USA
| | | | | | - Tomas Holubec
- Goethe University Frankfurt and University Hospital Frankfurt, Frankfurt, Germany
| | - Enrico Ferrari
- Cardiocentro Ticino Institute, Lugano, Switzerland.,University of Zurich, School of Medicine, Zurich, Switzerland
| | - Maximilian Y Emmert
- Charité Universitätsmedizin Berlin, Berlin, Germany.,German Heart Center Berlin, Berlin, Germany
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