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Meðferð höfuðstofnsþrenginga á Íslandi: : Víkkun, hjáveituaðgerð eða lyfjameðferð?

Meðferð höfuðstofnsþrenginga á Íslandi: : Víkkun, hjáveituaðgerð eða lyfjameðferð?

Title: Meðferð höfuðstofnsþrenginga á Íslandi: : Víkkun, hjáveituaðgerð eða lyfjameðferð?
Alternative Title: Management of patients with left main stem stenosis in Iceland 2010-2020PCI or CABG
Author: Reynisdottir, Heidrun Osk
Kristjansdottir, Margret Kristin
Mogensen, Brynjolfur Arni
Andersen, Karl
Gudbjartsson, Tomas   orcid.org/0000-0002-7281-5749
Sigurdsson, Martin Ingi
Gudmundsdottir, Ingibjorg J
Date: 2022-09-08
Language: Icelandic
Scope: 8
University/Institute: Landspítali
Department: Skrifstofa meðferðarsviðs
Skrifstofa aðgerðasviðs
Hjarta- og æðaþjónusta
Skurðstofur og gjörgæsla
Series: Læknablaðið; 108(9)
ISSN: 1670-4959
DOI: https://doi.org/10.17992/lbl.2022.09.704
Subject: Hjarta- og lungnaskurðlæknisfræði; Svæfinga- og gjörgæslulæknisfræði; Kransæðasjúkdómar; Kransæðavíkkanir; Hjartalæknisfræði; Constriction, Pathologic/complications; Coronary Artery Bypass/adverse effects; Coronary Artery Disease/diagnostic imaging; Humans; Iceland/epidemiology; Percutaneous Coronary Intervention/adverse effects; Retrospective Studies; Treatment Outcome; coronary artery disease; PCI; CABG; left main stem stenosis; coronary artery disease; left main stem stenosis; PCI; CABG; Læknisfræði (allt)
URI: https://hdl.handle.net/20.500.11815/3648

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Reynisdottir , H O , Kristjansdottir , M K , Mogensen , B A , Andersen , K , Gudbjartsson , T , Sigurdsson , M I & Gudmundsdottir , I J 2022 , ' Meðferð höfuðstofnsþrenginga á Íslandi: Víkkun, hjáveituaðgerð eða lyfjameðferð? ' , Læknablaðið , bind. 108 , nr. 9 , bls. 387-394 . https://doi.org/10.17992/lbl.2022.09.704


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.


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