Coronary artery bypass grafting versus stent implantation in patients with chronic coronary syndrome and left main disease: insights from a register throughout Germany,Clinical Research in Cardiology

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Coronary artery bypass grafting versus stent implantation in patients with chronic coronary syndrome and left main disease: insights from a register throughout Germany
Clinical Research in Cardiology ( IF 3.8 ) Pub Date : 2021-08-28 , DOI: 10.1007/s00392-021-01931-x
Peter Stachon _{1,

2} , Alexander Peikert ₁ , Dennis Wolf ₁ , Vera Oettinger _{1,

2} , Dawid Staudacher ₁ , Daniel Duerschmied ₁ , Manfred Zehender _{1,

2} , Christoph Bode ₁ , Constantin von zur Mühlen _{1,

2} , Klaus Kaier _{2,

3} , Philip Hehn _{2,

3} , Andreas Zirlik ₄

Affiliation

Background

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).

Methods

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.

Results

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).

Conclusion

Left main stenting is a safe and effective treatment option for CCS-patients suffering from left main coronary artery disease at reasonable economic cost.

Graphic abstract

中文翻译：

慢性冠状动脉综合征和左主干病变患者的冠状动脉旁路移植术与支架植入术：来自德国各地登记册的见解

背景

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的最佳治疗的争论。本研究分析了一项全国性登记处慢性冠状动脉综合征 (CCS) 患者左主干支架置入术与冠状动脉旁路移植术 (CABG) 的结果。

方法

在德国统计局的数据库中确定了所有使用 CABG 或支架治疗的 CCS 和左主干冠状动脉疾病的病例。Logistic 或线性回归模型使用 20 个基线患者特征作为潜在的混杂因素来比较两种方案。

结果

2018年CABG治疗左主干狭窄1318例，支架治疗8920例。根据logistic EuroSCORE（8.77 ± 8.45 vs. 4.85 ± 4.65，p < 0.001）评估，接受支架植入术的患者年龄较大（72.58 ± 9.87 vs. 68.63 ± 9.40，p < 0.001）且手术风险较高。风险调整后，院内死亡率和卒中的结果没有显着差异（支架而不是 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中风：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（aOR 0.16 [0.11; 0.22]，p < 0.001）。此外，支架植入与更短的住院时间（- 6.78 天 [- 5.86；- 7.71]，p < 0.001）和更低的成本（- 10,035 欧元 [- 11,500 欧元；- 8570 欧元]，p < 0.001）相关。