Readmission Rate After Coronary Artery Bypass Grafting Versus Percutaneous Coronary Intervention for Unprotected Left Main Coronary Artery Narrowing
Many studies have reported comparable risk of hard end points between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) for unprotected left main coronary artery (ULMCA) stenosis. However, there are limited data regarding the morbidity associated with ULMCA revascul...
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| Veröffentlicht in: | The American journal of cardiology 2014-05, Vol.113 (10), p.1639-1646 |
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| creator | Roh, Jae-Hyung, MD Kim, Young-Hak, MD, PhD Ahn, Jung-Min, MD, PhD Yun, Sung-Han, MD Lee, Jong-Bok, PhD Ge, Junhua, MD Le, Wang, MD Park, Gyung-Min, MD Lee, Jong-Young, MD, PhD Park, Duk-Woo, MD, PhD Kang, Soo-Jin, MD, PhD Lee, Seung-Whan, MD, PhD Lee, Cheol Whan, MD, PhD Park, Seong-Wook, MD, PhD Park, Seung-Jung, MD, PhD |
| description | Many studies have reported comparable risk of hard end points between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) for unprotected left main coronary artery (ULMCA) stenosis. However, there are limited data regarding the morbidity associated with ULMCA revascularization. This study sought to compare the cause and risk of readmissions after PCI and CABG for ULMCA stenosis. We evaluated the unadjusted and adjusted risk of readmissions in 1,352 patients (783 PCI treated and 569 CABG treated) who were consecutively enrolled in a multicenter registry of patients with ULMCA stenosis, named the Premier of Randomized Comparison of Bypass Surgery versus Angioplasty Using Sirolimus-Eluting Stent in Patients with Left Main Coronary Artery Disease trial. Overall, 206 PCI-treated patients (26.3%) experienced at least 1 readmission after the index procedure during 48.7 ± 16.0 months of follow-up compared with 84 CABG-treated patients (14.8%, p |
| doi_str_mv | 10.1016/j.amjcard.2014.02.013 |
| format | Article |
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However, there are limited data regarding the morbidity associated with ULMCA revascularization. This study sought to compare the cause and risk of readmissions after PCI and CABG for ULMCA stenosis. We evaluated the unadjusted and adjusted risk of readmissions in 1,352 patients (783 PCI treated and 569 CABG treated) who were consecutively enrolled in a multicenter registry of patients with ULMCA stenosis, named the Premier of Randomized Comparison of Bypass Surgery versus Angioplasty Using Sirolimus-Eluting Stent in Patients with Left Main Coronary Artery Disease trial. Overall, 206 PCI-treated patients (26.3%) experienced at least 1 readmission after the index procedure during 48.7 ± 16.0 months of follow-up compared with 84 CABG-treated patients (14.8%, p <0.001). The most frequent causes of readmission were repeat revascularization after PCI (41%) and noncardiac readmissions after CABG (48%). Through repeated events analysis, PCI was associated with more frequent readmissions than CABG (hazard ratio 2.037, 95% confidence interval 1.542 to 2.692, p <0.001), being an independent predictor of readmission (hazard ratio 1.820, 95% confidence interval 1.420 to 2.331, p <0.001). Except for the acute period, defined as the first 3 months, when there was no significant difference in readmission rate, a higher readmission rate after PCI was consistently observed over the remainder of the follow-up period. In conclusion, PCI was shown to be associated with a higher risk of readmission than CABG in treating ULMCA disease. This higher risk was attributable to more frequent revascularization in the PCI group.</description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/j.amjcard.2014.02.013</identifier><identifier>PMID: 24666619</identifier><identifier>CODEN: AJCDAG</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Angina pectoris ; Cardiology ; Cardiovascular ; Coronary Angiography ; Coronary Artery Bypass - methods ; Coronary Stenosis - diagnostic imaging ; Coronary Stenosis - surgery ; Coronary vessels ; Drug-Eluting Stents ; Female ; Follow-Up Studies ; Heart attacks ; Humans ; Incidence ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Patient Readmission - statistics & numerical data ; Percutaneous Coronary Intervention - methods ; Registries ; Republic of Korea - epidemiology ; Risk Assessment - methods ; Risk Factors ; Sirolimus - pharmacology ; Time Factors ; Treatment Outcome</subject><ispartof>The American journal of cardiology, 2014-05, Vol.113 (10), p.1639-1646</ispartof><rights>Elsevier Inc.</rights><rights>2014 Elsevier Inc.</rights><rights>Copyright © 2014 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited May 15, 2014</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c448t-82e27b39fe9ecf762816be4b4bee269a263ebc508da2dc3c5bf22b53c54781473</citedby><cites>FETCH-LOGICAL-c448t-82e27b39fe9ecf762816be4b4bee269a263ebc508da2dc3c5bf22b53c54781473</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/1520177983?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>315,781,785,3551,27929,27930,46000,64390,64392,64394,72474</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24666619$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Roh, Jae-Hyung, MD</creatorcontrib><creatorcontrib>Kim, Young-Hak, MD, PhD</creatorcontrib><creatorcontrib>Ahn, Jung-Min, MD, PhD</creatorcontrib><creatorcontrib>Yun, Sung-Han, MD</creatorcontrib><creatorcontrib>Lee, Jong-Bok, PhD</creatorcontrib><creatorcontrib>Ge, Junhua, MD</creatorcontrib><creatorcontrib>Le, Wang, MD</creatorcontrib><creatorcontrib>Park, Gyung-Min, MD</creatorcontrib><creatorcontrib>Lee, Jong-Young, MD, PhD</creatorcontrib><creatorcontrib>Park, Duk-Woo, MD, PhD</creatorcontrib><creatorcontrib>Kang, Soo-Jin, MD, PhD</creatorcontrib><creatorcontrib>Lee, Seung-Whan, MD, PhD</creatorcontrib><creatorcontrib>Lee, Cheol Whan, MD, PhD</creatorcontrib><creatorcontrib>Park, Seong-Wook, MD, PhD</creatorcontrib><creatorcontrib>Park, Seung-Jung, MD, PhD</creatorcontrib><title>Readmission Rate After Coronary Artery Bypass Grafting Versus Percutaneous Coronary Intervention for Unprotected Left Main Coronary Artery Narrowing</title><title>The American journal of cardiology</title><addtitle>Am J Cardiol</addtitle><description>Many studies have reported comparable risk of hard end points between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) for unprotected left main coronary artery (ULMCA) stenosis. However, there are limited data regarding the morbidity associated with ULMCA revascularization. This study sought to compare the cause and risk of readmissions after PCI and CABG for ULMCA stenosis. We evaluated the unadjusted and adjusted risk of readmissions in 1,352 patients (783 PCI treated and 569 CABG treated) who were consecutively enrolled in a multicenter registry of patients with ULMCA stenosis, named the Premier of Randomized Comparison of Bypass Surgery versus Angioplasty Using Sirolimus-Eluting Stent in Patients with Left Main Coronary Artery Disease trial. Overall, 206 PCI-treated patients (26.3%) experienced at least 1 readmission after the index procedure during 48.7 ± 16.0 months of follow-up compared with 84 CABG-treated patients (14.8%, p <0.001). The most frequent causes of readmission were repeat revascularization after PCI (41%) and noncardiac readmissions after CABG (48%). Through repeated events analysis, PCI was associated with more frequent readmissions than CABG (hazard ratio 2.037, 95% confidence interval 1.542 to 2.692, p <0.001), being an independent predictor of readmission (hazard ratio 1.820, 95% confidence interval 1.420 to 2.331, p <0.001). Except for the acute period, defined as the first 3 months, when there was no significant difference in readmission rate, a higher readmission rate after PCI was consistently observed over the remainder of the follow-up period. In conclusion, PCI was shown to be associated with a higher risk of readmission than CABG in treating ULMCA disease. This higher risk was attributable to more frequent revascularization in the PCI group.</description><subject>Angina pectoris</subject><subject>Cardiology</subject><subject>Cardiovascular</subject><subject>Coronary Angiography</subject><subject>Coronary Artery Bypass - methods</subject><subject>Coronary Stenosis - diagnostic imaging</subject><subject>Coronary Stenosis - surgery</subject><subject>Coronary vessels</subject><subject>Drug-Eluting Stents</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Heart attacks</subject><subject>Humans</subject><subject>Incidence</subject><subject>Kaplan-Meier Estimate</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Patient Readmission - statistics & numerical data</subject><subject>Percutaneous Coronary Intervention - methods</subject><subject>Registries</subject><subject>Republic of Korea - epidemiology</subject><subject>Risk Assessment - methods</subject><subject>Risk Factors</subject><subject>Sirolimus - 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methods</topic><topic>Coronary Stenosis - diagnostic imaging</topic><topic>Coronary Stenosis - surgery</topic><topic>Coronary vessels</topic><topic>Drug-Eluting Stents</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Heart attacks</topic><topic>Humans</topic><topic>Incidence</topic><topic>Kaplan-Meier Estimate</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Patient Readmission - statistics & numerical data</topic><topic>Percutaneous Coronary Intervention - methods</topic><topic>Registries</topic><topic>Republic of Korea - epidemiology</topic><topic>Risk Assessment - methods</topic><topic>Risk Factors</topic><topic>Sirolimus - pharmacology</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Roh, Jae-Hyung, MD</creatorcontrib><creatorcontrib>Kim, Young-Hak, MD, PhD</creatorcontrib><creatorcontrib>Ahn, Jung-Min, MD, PhD</creatorcontrib><creatorcontrib>Yun, Sung-Han, MD</creatorcontrib><creatorcontrib>Lee, Jong-Bok, PhD</creatorcontrib><creatorcontrib>Ge, Junhua, MD</creatorcontrib><creatorcontrib>Le, Wang, MD</creatorcontrib><creatorcontrib>Park, Gyung-Min, MD</creatorcontrib><creatorcontrib>Lee, Jong-Young, MD, PhD</creatorcontrib><creatorcontrib>Park, Duk-Woo, MD, PhD</creatorcontrib><creatorcontrib>Kang, Soo-Jin, MD, PhD</creatorcontrib><creatorcontrib>Lee, Seung-Whan, MD, PhD</creatorcontrib><creatorcontrib>Lee, Cheol Whan, MD, PhD</creatorcontrib><creatorcontrib>Park, Seong-Wook, MD, PhD</creatorcontrib><creatorcontrib>Park, Seung-Jung, MD, PhD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Physical Education Index</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Biochemistry Abstracts 1</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Roh, Jae-Hyung, MD</au><au>Kim, Young-Hak, MD, PhD</au><au>Ahn, Jung-Min, MD, PhD</au><au>Yun, Sung-Han, MD</au><au>Lee, Jong-Bok, PhD</au><au>Ge, Junhua, MD</au><au>Le, Wang, MD</au><au>Park, Gyung-Min, MD</au><au>Lee, Jong-Young, MD, PhD</au><au>Park, Duk-Woo, MD, PhD</au><au>Kang, Soo-Jin, MD, PhD</au><au>Lee, Seung-Whan, MD, PhD</au><au>Lee, Cheol Whan, MD, PhD</au><au>Park, Seong-Wook, MD, PhD</au><au>Park, Seung-Jung, MD, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Readmission Rate After Coronary Artery Bypass Grafting Versus Percutaneous Coronary Intervention for Unprotected Left Main Coronary Artery Narrowing</atitle><jtitle>The American journal of cardiology</jtitle><addtitle>Am J Cardiol</addtitle><date>2014-05-15</date><risdate>2014</risdate><volume>113</volume><issue>10</issue><spage>1639</spage><epage>1646</epage><pages>1639-1646</pages><issn>0002-9149</issn><eissn>1879-1913</eissn><coden>AJCDAG</coden><abstract>Many studies have reported comparable risk of hard end points between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) for unprotected left main coronary artery (ULMCA) stenosis. However, there are limited data regarding the morbidity associated with ULMCA revascularization. This study sought to compare the cause and risk of readmissions after PCI and CABG for ULMCA stenosis. We evaluated the unadjusted and adjusted risk of readmissions in 1,352 patients (783 PCI treated and 569 CABG treated) who were consecutively enrolled in a multicenter registry of patients with ULMCA stenosis, named the Premier of Randomized Comparison of Bypass Surgery versus Angioplasty Using Sirolimus-Eluting Stent in Patients with Left Main Coronary Artery Disease trial. Overall, 206 PCI-treated patients (26.3%) experienced at least 1 readmission after the index procedure during 48.7 ± 16.0 months of follow-up compared with 84 CABG-treated patients (14.8%, p <0.001). The most frequent causes of readmission were repeat revascularization after PCI (41%) and noncardiac readmissions after CABG (48%). Through repeated events analysis, PCI was associated with more frequent readmissions than CABG (hazard ratio 2.037, 95% confidence interval 1.542 to 2.692, p <0.001), being an independent predictor of readmission (hazard ratio 1.820, 95% confidence interval 1.420 to 2.331, p <0.001). Except for the acute period, defined as the first 3 months, when there was no significant difference in readmission rate, a higher readmission rate after PCI was consistently observed over the remainder of the follow-up period. In conclusion, PCI was shown to be associated with a higher risk of readmission than CABG in treating ULMCA disease. This higher risk was attributable to more frequent revascularization in the PCI group.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>24666619</pmid><doi>10.1016/j.amjcard.2014.02.013</doi><tpages>8</tpages></addata></record> |
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| subjects | Angina pectoris Cardiology Cardiovascular Coronary Angiography Coronary Artery Bypass - methods Coronary Stenosis - diagnostic imaging Coronary Stenosis - surgery Coronary vessels Drug-Eluting Stents Female Follow-Up Studies Heart attacks Humans Incidence Kaplan-Meier Estimate Male Middle Aged Patient Readmission - statistics & numerical data Percutaneous Coronary Intervention - methods Registries Republic of Korea - epidemiology Risk Assessment - methods Risk Factors Sirolimus - pharmacology Time Factors Treatment Outcome |
| title | Readmission Rate After Coronary Artery Bypass Grafting Versus Percutaneous Coronary Intervention for Unprotected Left Main Coronary Artery Narrowing |
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