Coronary Artery Bypass Surgery Compared with Percutaneous Coronary Intervention for Proximal Left Anterior Descending Artery Treatment in Patients with Acute Coronary Syndrome

Analysis from the ACUITY Trial

Marco G. Mennuni, George D. Dangas, Roxana Mehran, Yanai Ben-Gal, Ke Xu, Philippe Genereux, Sorin J. Brener, Frederick Feit, A. Michael Lincoff, E. Magnus Ohman, Martial Hamon, Gregg W. Stone

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

BACKGROUND: The optimal revascularization strategy in patients with acute coronary syndrome (ACS) and proximal left anterior descending (pLAD) coronary artery lesions is not well defined. The aim of this study was to compare the outcomes of ACS patients with pLAD culprit lesions receiving percutaneous coronary intervention (PCI) vs coronary artery bypass graft (CABG). METHODS: The ACUITY trial was a multicenter, prospective trial of patients with ACS treated with an early invasive strategy. Major adverse cardiac event (MACE; defined as death, myocardial infarction [MI], and repeat revascularization) and stroke were compared at 30 days and 1 year between PCI and CABG in patients with significant stenosis of the pLAD undergoing revascularization. Postprocedural major bleeding was evaluated at 30 days. RESULTS: Among patients with a significant pLAD stenosis (n ≤ 842), a total of 562 (66.7%) underwent PCI and 280 (33.3%) underwent CABG. Baseline characteristics, including age, sex, diabetes, and TIMI risk score, were well matched between groups; however, patients undergoing PCI were more likely to have had previous CABG (21.9% vs 6.4%; P<.001). Death, MI, MACE, and stroke rates did not differ between groups at 1 year. PCI patients had lower bleeding rates (8.1% vs 52.4%; P<.001) and blood product transfusion at 30 days (4.5% vs 41.3%; P<.001), but higher rates of unplanned revascularization at 1 year (12.7% vs 5.2%; P<.01). These results were consistent in patients with single vs multivessel disease and in diabetics vs non-diabetics. CONCLUSIONS: Among ACS patients with pLAD culprit lesions, an initial revascularization strategy of PCI compared with CABG yields similar 1-year death, MI, and MACE rates, although unplanned revascularization is more common after PCI.

Original languageEnglish (US)
Pages (from-to)468-473
Number of pages6
JournalJournal of Invasive Cardiology
Volume27
Issue number10
StatePublished - Oct 1 2015

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Percutaneous Coronary Intervention
Acute Coronary Syndrome
Coronary Artery Bypass
Arteries
Transplants
Therapeutics
Myocardial Infarction
Pathologic Constriction
Stroke
Hemorrhage
Blood Transfusion
Multicenter Studies
Coronary Vessels
Research Design

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Mennuni, Marco G. ; Dangas, George D. ; Mehran, Roxana ; Ben-Gal, Yanai ; Xu, Ke ; Genereux, Philippe ; Brener, Sorin J. ; Feit, Frederick ; Lincoff, A. Michael ; Ohman, E. Magnus ; Hamon, Martial ; Stone, Gregg W. / Coronary Artery Bypass Surgery Compared with Percutaneous Coronary Intervention for Proximal Left Anterior Descending Artery Treatment in Patients with Acute Coronary Syndrome : Analysis from the ACUITY Trial. In: Journal of Invasive Cardiology. 2015 ; Vol. 27, No. 10. pp. 468-473.
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abstract = "BACKGROUND: The optimal revascularization strategy in patients with acute coronary syndrome (ACS) and proximal left anterior descending (pLAD) coronary artery lesions is not well defined. The aim of this study was to compare the outcomes of ACS patients with pLAD culprit lesions receiving percutaneous coronary intervention (PCI) vs coronary artery bypass graft (CABG). METHODS: The ACUITY trial was a multicenter, prospective trial of patients with ACS treated with an early invasive strategy. Major adverse cardiac event (MACE; defined as death, myocardial infarction [MI], and repeat revascularization) and stroke were compared at 30 days and 1 year between PCI and CABG in patients with significant stenosis of the pLAD undergoing revascularization. Postprocedural major bleeding was evaluated at 30 days. RESULTS: Among patients with a significant pLAD stenosis (n ≤ 842), a total of 562 (66.7{\%}) underwent PCI and 280 (33.3{\%}) underwent CABG. Baseline characteristics, including age, sex, diabetes, and TIMI risk score, were well matched between groups; however, patients undergoing PCI were more likely to have had previous CABG (21.9{\%} vs 6.4{\%}; P<.001). Death, MI, MACE, and stroke rates did not differ between groups at 1 year. PCI patients had lower bleeding rates (8.1{\%} vs 52.4{\%}; P<.001) and blood product transfusion at 30 days (4.5{\%} vs 41.3{\%}; P<.001), but higher rates of unplanned revascularization at 1 year (12.7{\%} vs 5.2{\%}; P<.01). These results were consistent in patients with single vs multivessel disease and in diabetics vs non-diabetics. CONCLUSIONS: Among ACS patients with pLAD culprit lesions, an initial revascularization strategy of PCI compared with CABG yields similar 1-year death, MI, and MACE rates, although unplanned revascularization is more common after PCI.",
author = "Mennuni, {Marco G.} and Dangas, {George D.} and Roxana Mehran and Yanai Ben-Gal and Ke Xu and Philippe Genereux and Brener, {Sorin J.} and Frederick Feit and Lincoff, {A. Michael} and Ohman, {E. Magnus} and Martial Hamon and Stone, {Gregg W.}",
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Coronary Artery Bypass Surgery Compared with Percutaneous Coronary Intervention for Proximal Left Anterior Descending Artery Treatment in Patients with Acute Coronary Syndrome : Analysis from the ACUITY Trial. / Mennuni, Marco G.; Dangas, George D.; Mehran, Roxana; Ben-Gal, Yanai; Xu, Ke; Genereux, Philippe; Brener, Sorin J.; Feit, Frederick; Lincoff, A. Michael; Ohman, E. Magnus; Hamon, Martial; Stone, Gregg W.

In: Journal of Invasive Cardiology, Vol. 27, No. 10, 01.10.2015, p. 468-473.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Coronary Artery Bypass Surgery Compared with Percutaneous Coronary Intervention for Proximal Left Anterior Descending Artery Treatment in Patients with Acute Coronary Syndrome

T2 - Analysis from the ACUITY Trial

AU - Mennuni, Marco G.

AU - Dangas, George D.

AU - Mehran, Roxana

AU - Ben-Gal, Yanai

AU - Xu, Ke

AU - Genereux, Philippe

AU - Brener, Sorin J.

AU - Feit, Frederick

AU - Lincoff, A. Michael

AU - Ohman, E. Magnus

AU - Hamon, Martial

AU - Stone, Gregg W.

PY - 2015/10/1

Y1 - 2015/10/1

N2 - BACKGROUND: The optimal revascularization strategy in patients with acute coronary syndrome (ACS) and proximal left anterior descending (pLAD) coronary artery lesions is not well defined. The aim of this study was to compare the outcomes of ACS patients with pLAD culprit lesions receiving percutaneous coronary intervention (PCI) vs coronary artery bypass graft (CABG). METHODS: The ACUITY trial was a multicenter, prospective trial of patients with ACS treated with an early invasive strategy. Major adverse cardiac event (MACE; defined as death, myocardial infarction [MI], and repeat revascularization) and stroke were compared at 30 days and 1 year between PCI and CABG in patients with significant stenosis of the pLAD undergoing revascularization. Postprocedural major bleeding was evaluated at 30 days. RESULTS: Among patients with a significant pLAD stenosis (n ≤ 842), a total of 562 (66.7%) underwent PCI and 280 (33.3%) underwent CABG. Baseline characteristics, including age, sex, diabetes, and TIMI risk score, were well matched between groups; however, patients undergoing PCI were more likely to have had previous CABG (21.9% vs 6.4%; P<.001). Death, MI, MACE, and stroke rates did not differ between groups at 1 year. PCI patients had lower bleeding rates (8.1% vs 52.4%; P<.001) and blood product transfusion at 30 days (4.5% vs 41.3%; P<.001), but higher rates of unplanned revascularization at 1 year (12.7% vs 5.2%; P<.01). These results were consistent in patients with single vs multivessel disease and in diabetics vs non-diabetics. CONCLUSIONS: Among ACS patients with pLAD culprit lesions, an initial revascularization strategy of PCI compared with CABG yields similar 1-year death, MI, and MACE rates, although unplanned revascularization is more common after PCI.

AB - BACKGROUND: The optimal revascularization strategy in patients with acute coronary syndrome (ACS) and proximal left anterior descending (pLAD) coronary artery lesions is not well defined. The aim of this study was to compare the outcomes of ACS patients with pLAD culprit lesions receiving percutaneous coronary intervention (PCI) vs coronary artery bypass graft (CABG). METHODS: The ACUITY trial was a multicenter, prospective trial of patients with ACS treated with an early invasive strategy. Major adverse cardiac event (MACE; defined as death, myocardial infarction [MI], and repeat revascularization) and stroke were compared at 30 days and 1 year between PCI and CABG in patients with significant stenosis of the pLAD undergoing revascularization. Postprocedural major bleeding was evaluated at 30 days. RESULTS: Among patients with a significant pLAD stenosis (n ≤ 842), a total of 562 (66.7%) underwent PCI and 280 (33.3%) underwent CABG. Baseline characteristics, including age, sex, diabetes, and TIMI risk score, were well matched between groups; however, patients undergoing PCI were more likely to have had previous CABG (21.9% vs 6.4%; P<.001). Death, MI, MACE, and stroke rates did not differ between groups at 1 year. PCI patients had lower bleeding rates (8.1% vs 52.4%; P<.001) and blood product transfusion at 30 days (4.5% vs 41.3%; P<.001), but higher rates of unplanned revascularization at 1 year (12.7% vs 5.2%; P<.01). These results were consistent in patients with single vs multivessel disease and in diabetics vs non-diabetics. CONCLUSIONS: Among ACS patients with pLAD culprit lesions, an initial revascularization strategy of PCI compared with CABG yields similar 1-year death, MI, and MACE rates, although unplanned revascularization is more common after PCI.

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M3 - Article

VL - 27

SP - 468

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JO - Journal of Invasive Cardiology

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