Læknablaðið - 01.09.2022, Blaðsíða 18

394 L ÆKNABL AÐIÐ 2022/108
R A N N S Ó K N
E N G L I S H S U M M A R Y
Management of patients with left main stem stenosis in Iceland 2010-2020: PCI or CABG
Introduction: Coronary artery bypass surgery (CABG) has been standard treatment for patients with
left main coronary artery disease (LMCAD) but percutaneous coronary intervention (PCI) can be a good
alternative. Our aim was to evaluate revascularization of LMCAD-patients in Iceland and treatment changes
in recent years. We also assessed the impact of patient background factors on treatment choice and long-
term survival.
Methods: This retrospective, population-based registry-study analyzed data from the SCAAR-SWEDEHEART
database. Patients with significant LMCAD on coronary angiography in Iceland 2010-2020, without previous
history of CABG or contraindication for surgery were enrolled. The Kaplan-Meier method was used to study
long-term survival and COX-regression analysis to adjust for predictor variables.
Findings: Of 702 LMCAD patients, 195 were treated with PCI, 460 with CABG and 47 with medical therapy.
The widest age-range was in the PCI group and the mean age was highest in the medical therapy group.
Patients with LMCAD and concomitant three vessel disease or heart valve disese were mostly treated with
CABG (76.1% and 84.4%). The majority of patients with LMCAD only were treated with PCI, as well as patients
presenting with STEMI or in cardiogenic shock (67.1% and 70.0%). The proportion of patients treated with PCI
increased from 19.8% in 2010-2015 to 42.7% in 2016-2020. There was no significant difference in survival
between the PCI and CABG-groups (p=0.41).
Conclusions: In patients with LMCAD the main factors determining treatment choice are age, anatomical
complexity and acuteness. There has been a significant increase in LMCAD patients treated with PCI.
doi 10.17992/lbl.2022.09.704
Heiðrún Ósk Reynisdóttir1
Margrét Kristín Kristjánsdóttir1
Brynjólfur Árni Mogensen2
Karl Andersen1,2
Tómas Guðbjartsson1,3
Martin Ingi Sigurðsson1,4
Ingibjörg J. Guðmundsdóttir1,2
1Faculty of Medicine, University of Iceland,
Departments of 2Cardiology, 3Cardiothoracic
surgery, 4Anesthesiology & Critical Care, Landspitali
- The National University Hospital of Iceland.
Correspondence: Ingibjörg J. Guðmundsdóttir,
ig@landspitali.is
Key words: coronary artery disease, left main stem
stenosis, PCI, CABG.
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