Background: The optimal revascularization strategy for patients with left main coronary artery (LMCA) disease has been repeatedly addressed in randomized controlled trials (RCTs), although outcomes from real-life clinical studies are still poorly investigated. Objectives: This retrospective study aimed to assess the complete 5-year outcomes for individuals with multivessel coronary artery disease (MVD) involving LMCA disease treated with coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) as recommended by a local HT. Methods: From 2016 to 2019, 176 Heart Team (HT) meetings were held. Primary and secondary endpoints of 267 patients with MVD involving LMCA disease qualified either for CABG or PCI (109 and 158 patients, respectively) with subsequent optimal medical therapy (OMT) were assessed. The primary endpoint of the study was as an overall mortality, while secondary endpoints contained major adverse cardiac and cerebrovascular events (MACCE)—specifically, stroke, myocardial infarction (MI), repeat revascularization (RR), and the individual components of MACCE. Results: At 5 years, we found no significant difference in overall mortality between the both cohorts (22.9%-CABG vs. 24.7%-PCI, p = 0.74). The rate of MI was higher in patients treated percutaneously (7.3% vs. 15.8% for PCI, p = 0.04), while the incidence of stroke was higher in patients who underwent CABG (3.8% vs. 11.0% for CABG, p = 0.02). A MACCE occurrence was higher in PCI cohort (77.2% vs. 55.0%, p < 0.001), mainly driven by higher rates of RR was higher in patients treated percutaneously (32.9% vs. 13.8%, p < 0.001). Conclusions: For patients with LMCA disease, neither CABG nor PCI following HT decisions showed overwhelming superiority in real-life clinical practice: occurrence of all-cause death was similar, rates of MACCE, MI, and repeat revascularization advocated CABG, while incidence of strokes favored PCI.

BACKGROUND For patients with multivessel coronary artery disease (MVD) treated with coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI), we proposed novel pulmonary risk factors identified by machine learning (ML) that have impact on long-term revascularization outcomes. METHODS A total of 1035 consecutive patients with three-vessel disease (3-VD) and/or left main disease (LMD) treated with either CABG or PCI were followed up to 5 years in tertiary cardiovascular care centre that systematically screened their candidates for revascularization. Participants were stratified for the presence of absence of PH (pulmonary hypertension) and /or chronic obstructive pulmonary disease (COPD), and the impact of each on revascularization outcomes was examined. RESULTS Five-year mortality in overall cohort was 12.6%. A higher mortality was demonstrated for patients with diagnosis of COPD or PH (n=125) as compared with population who had neither COPD nor PH (n=910) [68.8% vs 4.8%, P< 0.001]. Among the 125 patients in COPD/PH population, a higher 5-year mortality was observed in those who underwent surgery as compared with PCI-group (85.2% vs 64.3%, P=0.04). We observed a significant interaction between COPD and revascularization strategy (P=0.014), but no association between PH and CABG/PCI was found. Cox regression analysis showed outstanding HRs of mortality for PH (6.01 [3.47-10.40]) and COPD (5.65 [3.21-9.96]) as compared with conventional risk factors. CONCLUSIONS In the overall cohort, novel pulmonary risk factors suggested by ML had a huge impact on 5-year mortality, hence a detailed diagnosis of pulmonary disease in the population with MVD has a paramount importance to predict long-term mortality.

Objectives: The aim of this study is to evaluate the safety and efficacy of repeat transcatheter aortic valve implantation (redo-TAVI) in the polish population. Methods: In this multicentre nationwide registry (ClinicalTrials.gov identifier, NCT03361046), we provide characteristics, periprocedural variables and long-term outcomes of high-risk patients who underwent redo-TAVI. Results: The mean age among 32 individuals who underwent redo-TAVI was 75 ± 13 years, and 62.5% were male. The mean time from index TAVI to redo-TAVI was 4.7 ± 3.5 years, with failed procedures (up to 1 year) occurring in 7 (21.9%) and failed transcatheter heart valve (THV, beyond 1 year) in the remaining majority of the 25 (78.1%) patients. Computed tomography-based native bicuspid aortic anatomy was found frequently in 37.5% of cases (58.3% in failed procedures and 41.7% in failed THV). The mean failed THV size was large (27.7 ± 3 mm) and predominantly presenting with pure regurgitation (59.4%). In more than two-thirds (68.7%), balloon-expandable or self-expandable THV was the most common strategy of redo-TAVI. None or mild regurgitation was found in 90.6%, and the mean transvalvular gradient was 13.1 ± 5.5 mmHg, with only three cases with >20 mmHg of the residual gradient (9.4%). Peri-procedural and 30-day complications were low, and cardiovascular and all-cause mortality at 1 year was 9.4 and 15.6%, respectively. There was a relatively high incidence of non-procedural stroke after redo-TAVI (n = 5, 15.6%), with all cases observed after 30 days. Conclusions: Initial data of redo-TAVI in Poland suggest that the procedure is safe and characterized by favourable efficacy and low rates of short-term adverse outcomes. A high frequency of baseline native bicuspid anatomy and late stroke occurrence after the redo-procedure warrants further investigation in larger cohorts.