JR DIVISI EMERGENSI

DR. DUAS JOURGIE SIMATUPANG

PEMBIMBING :
PROF. DR. HARIS HASAN, SP.PD, SP.JP (K)
 INTRODUCTION

• CAD  LV DYSFUNCTION
• MEDIUM TERM (3-5 YEARS) LMCA DISEASE  CABG VS PCI
• LMCA DISEASE WITH HIGH-RISK CLINICAL AND ANATOMIC DISEASE  CABG >>
• EVALUATE TREATMENT REVASCULARIZATION ACCORDING TO SEVERITY OF LV
DYSFUNCTION IN LMCA  IRIS-MAIN ( INTERVENTIONAL RESEARCH
INCORPORATION SOCIETY-LEFT MAIN REVASCULARIZATION) REGISTRY
 METHODS

• STUDY POPULATION  IRIS-MAIN REGISTRY ( NONRANDOMIZED, MULTINATIONAL,

OBSERVATIONAL) LMCA DISEASE TREATED WITH PCI/CABG/MEDICATION
• 50 ACADEMIC & COMMUNITY HOSPITALS (INCL INDONESIA)
• EXCLUSION CRITERIA :
• PRIOR CABG
• UNDERWENT VALVULAR SURGERY
• TERMINAL MALIGNANCY

• CATEGORIZED ACCORDING SEVERITY OF LV DYSFUNCTION

 STUDY OUTCOMES AND FOLLOW-UP

• PRIMARY OUTCOME  DEATH, MI AND STROKE

• SECONDARY  ALL CAUSE MORTALITY OR REPEAT REVASCULARIZATION
• 1 MONTH, 6 MONTHS AND 1 YEAR
• LV FUNCTION
• CORONARY ANGIOGRAPHY FINDING
• PROCEDURAL/OPERATIVE
• OUTCOME DATA
 STATISTICAL ANALYSIS

• LONGTERM OUTCOMES CABG VS PCI ACCORDING SEVERITY OF LV

DYSFUNCTION
• CATEGORIC VARIABLES  PERCENTAGES (= PEARSON OR FISHER)
• CONTINOUS VARIABLES  MEAN (= STUDENT T-TEST)
• CLINICAL OUTCOME AFTER CABG AND PCI  KAPLAN-MEIER METHOD
 RESULTS

• OVERALL IN EACH GROUP OF LV DYSFUNCTION  CABG PATIENT HAD A HIGHER

RISK FACTOR COMORBID
• SEVERE DEGREE OF LV DYSFUNCTION TENDED TO OLDER PATIENT
• PHARMACOLOGICAL TREATMENT  CABG << PCI
LONG-TERM CLINICAL OUTCOMES

• MEDIAN FOLLOW-UP DURATION 3.8 YEARS ( 2.1 – 5.5 YEARS)

• MORTALITY RATE : SEVERE LV DYSFUNCTION  PCI >>> CABG
• REPEAT REVASCULARIZATION  PCI >>> CABG
DISCUSSION

• MAJOR FINDING THIS STUDY :

• < LVEF  INDEPENDENT PREDICTOR CLINICAL ENDPOINT AND ALL CAUSE MORTALITY
• < LVEF + PCI/CABG  RELATIVE RISK OF 5 YEAR PRIMARY OUTCOME
• MODERATE – SEVERE LVEF DYSFUNCTION  PCI >> HIGHER RISK
• PCI CONSISTENTLY ASSOCIATED REPEAT REVASCULARIZATION
 STUDY LIMITATIONS

• NON RANDOMIZED, OBSERVATIONAL STUDY

• OPERATOR EXPERIENCE CANNOT QUAINTIFY
• LIMITED SERIAL ECHOCARDIOGRAPHY FOLLOW UP
 CONCLUSIONS

• SEVERITY OF LV DYSFUNCTION CONSIDERED AS THE KEY FACTOR OF OPTIMAL

REVASCULARIZATION FOR PATIENTS WITH LMCA DISEASE
TERIMA KASIH