Yu Na Kim

TCT-242 Temporal Changes in Outcomes after Stent or Coronary Artery Bypass Grafting for Left Main Coronary Artery Disease by Diabetes Status.

nos: 242 249 TCT-242 Temporal Changes in Outcomes after Stent or Coronary Artery Bypass Grafting for Left Main Coronary Artery Disease by Diabetes Status Min Soo Cho, Ungjeong Do, Kyusup Lee, Jung Ae Hong, Osung Kwon, Do-yoon Kang, Jaeseokf Bae, Cheol Hyun Lee, Yu Na Kim, Se Hun Kang, Sung-Han Yoon, Pil Hyung Lee, Jung-Min Ahn, Duk-Woo Park, Soo-Jin Kang, Seung-Whan Lee, Young-Hak Kim, Cheol Whan Lee, Seong-Wook Park, Seung-Jung Park Asan medical center, Seoul, Korea, Republic of; Seoul National University Hospital, Seoul, Korea, Republic of; AMC, Seoul, Korea, Republic of; Asan Medical Center, Seoul, Korea, Republic of; Asan Medical Center, Seoul, Korea, Republic of; Asan Medical Center, Seoul, Korea, Republic of; Asan medical center, Seoul, Korea, Republic of; Asan medical center, seoul, Korea, Republic of; Asan Medical Center, Seoul, Korea, Republic of; Asan Medical Center, Seoul, Korea, Republic of; Asan Medical Center, Seoul, Korea, Republic of; Columbia University Medical Center, Seoul, Korea, Republic of; Asan Medical Center, Seoul, Korea, Republic of; Asan Medical Center, Seoul, Korea, Republic of; Asan Medical Center, Seoul, Korea, Republic of; Asan Medical Center, Seoul, Korea, Republic of; Asan Medical Center, Seoul, Korea, Republic of; Asan Medical Center, Seoul, Korea, Republic of; Asan Medical Center, Seoul, Korea, Republic of; Asan Medical Center, Seoul, Korea, Republic of BACKGROUND Diabetes mellitus is a well-known determinant of outcomes after coronary revascularization. The secular trend in the relative treatment effects of stenting and coronary-artery bypass grafting (CABG) by diabetes status remains unknown in patients with unprotected left main coronary artery (ULMCA) disease. METHODS We analyzed 5217 consecutive patients with ULMCA treated with stenting (n 1⁄4 2866) or CABG (n 1⁄4 2351) enrolled in the Interventional Research Incorporation Society – Left MAIN Revascularization registry. Participants were classified by time period based on stent type: wave 1, 1995–2002 (bare-metal stents); wave 2, 2003–2006 (first-generation drug-eluting stents [DES]); and wave 3, 2007–2013 (second-generation DES). The primary outcome was a major adverse cardiac or cerebrovascular event (MACCE), defined as composite of death, myocardial infarction, stroke, or repeat revascularization. J O U R N A L O F T H E A M E R I C A N C O L L E G E O F C A R D I O L O G Y , V O L . 6 8 , N O . 1 8 , S U P P L B , 2 0 1 6 B99 RESULTS Overall, patients without diabetes treated with stenting compared with CABG had higher 3-year rates of MACCE (17.3% vs. 13.4%; P 1⁄4 0.002), but a trend toward markedly improving outcomes of stenting compared to CABG was observed over time (wave 1, 30.5% vs. 14.3%; wave 2, 20.7% vs. 13.4%; and wave 3, 12.1% vs. 12.2%, respectively). Among patients with diabetes, the 3-year rates of MACCE were significantly higher in the stenting than in the CABG group (23.5% vs. 16.5%; P < 0.001) and this trend did not change over time (wave 1, 25.9% vs. 16.4%; wave 2, 23.4% vs. 16.2%; and wave 3, 23.5% vs. 17.0%, respectively). After multivariate adjustment, the hazard ratios for MACCE after stenting compared with CABG substantially changed over time in non-diabetic population (wave 1, 3.05; wave 2, 2.16; and wave 3, 1.13; respectively; P < 0.001), but not in diabetic population (wave 1, 2.58; wave 2, 1.94; and wave 3, 1.72, respectively; P 1⁄4 0.75). CONCLUSION In non-diabetic patients with ULMCA disease, treatment effect of stenting has been much improved over time and comparable to CABG in the current era. However, in diabetic population, CABG was consistently better than stenting. CATEGORIES CORONARY: Angioplasty Overview and Outcomes TCT-243 Second generation drug-eluting stents or coronary bypass surgery in patients with three-vessel coronary disease Reo Hata, Kazushige Kadota, Yusuke Hyodo, Suguru Otsuru, Seiji Habara, Hiroyuki Tanaka, Yasushi Fuku, Tsuyoshi Goto Kurashiki Central Hospital, Kurashiki, Japan; Kurashiki Central Hospital, Kurashiki, Japan; Kurashiki central hospital; Kurashiki City, Japan; Kurashiki central hospital, Okayama, Japan; Kurashiki Central Hospital, Kurashiki, Japan; Kurashiki Central Hospital, Kurashiki, Japan; Kurashiku, Okayama, Japan BACKGROUND Few studies comparing percutaneous coronary intervention (PCI) with coronary artery bypass grafting (CABG) in patients with three-vessel coronary disease (3VD) have made use of second generation drug-eluting stents (G2DES). METHODS We analyzed Japanese patients with 3VD undergoing first PCI with G2DES or CABG between 2010 and 2014. The primary outcome was a compisite of all-cause death, non-fatal myocardial infarction (MI), and stroke, and the secondary outcome was target vessel revascularisation (TVR). Propensity-score matching was used to adjust a cohort of patients with similar baseline characteristics. RESULTS Among 469 eligible patients (298 patients, PCI group; 171 patients, CABG group), 128 patients undergoing PCI with G2DES and 128 patients undergoing CABG had similar propensity scores and were included in the analysis. The median follow-up interval was 998 days, and the patient characteristics were shown in the table. At 2 years, the unajusted primary outcome event rates in the PCI and CABG groups were 10.8% and 11.8% (log-rank p1⁄40.60), and the rates of TVR were 22.0% and 5.3% (log-rank p<0.001). After propensity-score matching, PCI with G2DES was associated with similar risk of a composite outcome of death, MI, and stroke as compared with CABG (hazard ratio, 1.02; 95% confidence interval [CI], 0.52 to 2.03; p1⁄40.95), and higher risk of TVR (hazard ratio, 3.49; 95% CI, 1.58 to 7.71; p1⁄40.002). Variables PCI(n[298) CABG (n[171) p value Age, yrs 71.1 11.4 68.1 9.6 0.004 Men, n (%) 217 (73) 192 (80) 0.08 Hypertension, n (%) 238 (80) 200 (84) 0.71 Diabetes mellitus, n (%) 157 (53) 97 (57) 0.40

TCT-258 Clinical significance of peri-procedural myocardial infarction following percutaneous coronary intervention for multi-vessel coronary artery disease.

The prevalence and prognostic implications of current peri-procedural myocardial infarction (periMI) definitions in real-world practice were not well evaluated to date. The Asan-MV registry was consisted of consecutive patients whose peri-procedural creatinine kinase-MB mass was routinely measured