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=Volume 9 - 2022

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=BACKGROUND: Data regarding management of patients with unprotected left main coronary artery in-stent restenosis (LM-ISR) are scarce. 
OBJECTIVES: This study investigated the safety and effectiveness of percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) for the treatment of unprotected LM-ISR.
METHODS: 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. 
RESULTS: 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% versus 7.1%,HR 3.48, 95%CI 1.01-11.8,p=0.04). At a median of 3.5 years (interquartile range (IQR) 1.3–5.5) follow-up, MACCE occurred in 27.7% versus 30.6% (HR 0.86, 95%CI 0.54-1.36,p=0.53) in PCI- and CABG-treated patients, respectively. There were no significant differences between PCI and CABG in cardiac death (9.9% versus 19.4%; HR 1.65, 95%CI 0.87-3.15,p=0.12), MI (7.9% versus 5.1%, HR 0.44, 95%CI 0.15-1.27,p=0.13), or stroke (2.1% versus 4.1%, HR 1.78, 95%CI 0.44-7.16,p=0.41). TVR was more frequently needed in the PCI group (15.2% versus 6.1%, HR 0.35, 95%CI 0.14-0.85,p=0.02).
CONCLUSIONS: 
This analysis of LM-ISR patients 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.