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Left ventricular systolic dysfunction in patients with unprotected left main coronary artery disease

Linksventrikuläre systolische Dysfunktion bei Patienten mit koronarer Herzkrankheit des ungeschützten linken Hauptstamms

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An Erratum to this article was published on 17 June 2020

This article has been updated

Abstract

Background

The optimal coronary revascularization strategy for patients with unprotected left main coronary artery (ULMCA) disease and left ventricular systolic dysfunction (LVSD) remains uncertain. The purpose of this study was to evaluate the clinical outcomes after percutaneous coronary intervention (PCI) with a drug-eluting stent (DES) versus coronary artery bypass grafting (CABG) in patients with ULMCA disease with or without LVSD.

Methods

A total of 984 patients with ULMCA disease who received a DES (n = 511) or underwent CABG (n = 473) were included in this study. We retrospectively analyzed the clinical parameters and outcomes of ULMCA disease patients with different left ventricular ejection fraction levels.

Results

There were no significant differences in major adverse cardiac and cerebral events, all-cause death, cardiac death, myocardial infarction, or stroke between the CABG and DES groups with or without LVSD. The rate of target vessel revascularization was significantly higher with DES compared with CABG in patients without LVSD; however, the difference was not significant between the mild LVSD and severe LVSD groups.

Conclusion

For patients with ULMCA disease and LVSD, there was no significant difference between DES and CABG in terms of efficacy and safety. Treatment with DES was an acceptable alternative to CABG.

Zusammenfassung

Hintergrund

Die optimale Strategie zu Koronargefäßrevaskularisierung bei Patienten mit koronarer Herzkrankheit (KHK) des ungeschützten linken Hauptstamms (ULMCA) und linksventrikulärer systolischer Dysfunktion (LVSC) bleibt ungewiss. Ziel der vorliegenden Studie war es, die klinischen Ergebnisse nach perkutaner Koronarintervention (PCI) mit einem medikamentenfreisetzenden Stent (DES) vs. Koronararterien-Bypass-Operation (CABG) bei Patienten mit ULMCA-KHK mit oder ohne LVSD zu untersuchen.

Methoden

In die Studie wurden 984 Patienten mit ULMCA-KHK aufgenommen, die mittels DES (n = 511) oder CABG (n = 473) versorgt wurden. Retrospektiv wurden die klinischen Parameter und Ergebnisse der Patienten mit ULMCA-KHK mit verschiedenen linksventrikulären Ejektionsfraktionswerten analysiert.

Ergebnisse

Es gab keine signifikanten Unterschiede zwischen der CABG- und DES-Gruppe mit oder ohne LVSD bei schweren unerwünschten kardialen und zerebralen Ereignissen, Tod jeglicher Ursache, Herztod, Myokardinfarkt oder Schlaganfall. Die Rate an Zielgefäßrevaskularisierungen war für Patienten ohne LVSD bei Behandlung mit einem DES signifikant höher als bei CABG-Therapie; allerdings war der Unterschied zwischen der Gruppe mit leichtgradiger LVSD und der Gruppe mit schwerer LVSD nicht signifikant.

Schlussfolgerung

Für Patienten mit ULMCA-KHK und LVSD bestand kein signifikanter Unterschied zwischen der Therapie mit DES und CABG hinsichtlich der Wirksamkeit und Sicherheit. Die Behandlung mit einem DES stellte eine akzeptable Alternative zur CABG-Therapie dar.

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Acknowledgements

This work was supported by the National Key Research and Development Program of China (2016YFC1301000, 2016YFC1301002), and grants from Beijing Municipal Commission of Science and Technology (D151100002215004). We also acknowledge with great appreciation the patients who participated in this study.

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Authors and Affiliations

  1. Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, Beijing, China

    Yu Pan MD,  Xian-peng Yu &  Jian-zeng Dong

  2. Department of Pharmacy, Beijing Anzhen Hospital, Capital Medical University, Beijing, China

    Qi Qiu PhD

  3. Department of Pathology, Aviation General Hospital of China Medical University, China Medical University, Beijing, China

    Wei-hong Ren MD

  4. Department of Cardiology, Beijing Luhe Hospital, Capital Medical University, Beijing, China

    Ze-sen Liu MD

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  1. Yu Pan MD
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  2. Qi Qiu PhD
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  3. Wei-hong Ren MD
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  4. Xian-peng Yu
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  5. Ze-sen Liu MD
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  6. Jian-zeng Dong
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Correspondence to Jian-zeng Dong.

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Conflict of interest

Y. Pan, Q. Qiu, W.‑h. Ren, X.‑p. Yu, Z.‑s. Liu and J.‑z. Dong declare that they have no competing interests.

All procedures performed in studies involving human participants or on human tissue were in accordance with the ethical standards of the institutional and/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the Human Research Committee of Capital Medical University. Informed consent was obtained from all individual participants included in the study.

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Pan, Y., Qiu, Q., Ren, Wh. et al. Left ventricular systolic dysfunction in patients with unprotected left main coronary artery disease. Herz 46, 262–268 (2021). https://doi.org/10.1007/s00059-020-04934-y

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