AUTHOR=Wańha Wojciech , Bil Jacek , Kołodziejczak Michalina , Kowalówka Adam , Kowalewski Mariusz , Hudziak Damian , Gocoł Radosław , Januszek Rafał , Figatowski Tomasz , Milewski Marek , Tomasiewicz Brunon , Kübler Piotr , Hrymniak Bruno , Desperak Piotr , Kuźma Łukasz , Milewski Krzysztof , Góra Bartłomiej , Łoś Andrzej , Kulczycki Jan , Włodarczak Adrian , Skorupski Wojciech , Grygier Marek , Lesiak Maciej , D'Ascenzo Fabrizio , Andres Marek , Kleczynski Paweł , Litwinowicz Radosław , Borin Andrea , Smolka Grzegorz , Reczuch Krzysztof , Gruchała Marcin , Gil Robert J. , Jaguszewski Miłosz , Bartuś Krzysztof , Suwalski Piotr , Dobrzycki Sławomir , Dudek Dariusz , Bartuś Stanisław , Ga̧sior Mariusz , Ochała Andrzej , Lansky Alexandra J. , Deja Marek , Legutko Jacek , Kedhi Elvin , Wojakowski Wojciech 

TITLE=Percutaneous Coronary Intervention vs. Coronary Artery Bypass Grafting for Treating In-Stent Restenosis in Unprotected-Left Main: LM-DRAGON-Registry

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=9

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.849971

DOI=10.3389/fcvm.2022.849971

ISSN=2297-055X

ABSTRACT=<sec><title>Background</title><p>Data regarding management of patients with unprotected left main coronary artery in-stent restenosis (LM-ISR) are scarce.</p></sec><sec><title>Objectives</title><p>This study investigated the safety and effectiveness of percutaneous coronary intervention (PCI) vs. coronary artery bypass grafting (CABG) for the treatment of unprotected LM-ISR.</p></sec><sec><title>Methods</title><p>Consecutive patients who underwent PCI or CABG for unprotected LM-ISR were enrolled. The primary endpoint was a composite of major adverse cardiac and cerebrovascular events (MACCE), defined as cardiac death, myocardial infarction (MI), target vessel revascularization (TVR), and stroke.</p></sec><sec><title>Results</title><p>A total of 305 patients were enrolled, of which 203(66.6%) underwent PCI and 102(33.4%) underwent CABG. At 30-day follow-up, a lower risk of cardiac death was observed in the PCI group, compared with the CABG-treated group (2.1% vs. 7.1%, <italic>HR</italic> 3.48, 95%<italic>CI</italic> 1.01–11.8, <italic>p</italic> = 0.04). At a median of 3.5 years [interquartile range (<italic>IQR</italic>) 1.3–5.5] follow-up, MACCE occurred in 27.7% vs. 29.6% (<italic>HR</italic> 0.82, 95%<italic>CI</italic> 0.52–1.32, <italic>p</italic> = 0.43) in PCI- and CABG-treated patients, respectively. There were no significant differences between PCI and CABG in cardiac death (9.9% vs. 18.4%; <italic>HR</italic> 1.56, 95%<italic>CI</italic> 0.81–3.00, <italic>p</italic> = 0.18), MI (7.9% vs. 5.1%, <italic>HR</italic> 0.44, 95%<italic>CI</italic> 0.15–1.27, <italic>p</italic> = 0.13), or stroke (2.1% vs. 4.1%, <italic>HR</italic> 1.79, 95%<italic>CI</italic> 0.45–7.16, <italic>p</italic> = 0.41). TVR was more frequently needed in the PCI group (15.2% vs. 6.1%, HR 0.35, 95%<italic>CI</italic> 0.15–0.85, <italic>p</italic> = 0.02).</p></sec><sec><title>Conclusions</title><p>This analysis of patients with LM-ISR revealed a lower incidence of cardiac death in PCI compared with CABG in short-term follow-up. During the long-term follow-up, no differences in MACCE were observed, but patients treated with CABG less often required TVR.</p></sec><sec><title>Visual overview</title><p>A visual overview is available for this article.</p></sec><sec><title>Registration</title><p><ext-link ext-link-type="uri" xlink:href="https://www.clinicaltrials.gov" xmlns:xlink="http://www.w3.org/1999/xlink">https://www.clinicaltrials.gov</ext-link>; Unique identifier: NCT04968977.</p></sec>