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Surgical versus interventional procedures in patients with multivessel coronary artery disease
P Redondo1, C M Pérez, R A Cox
1Department of Medicine, University of Puerto Rico School of Medicine, San Juan 00936-5067.
Insights
Percutaneous transluminal coronary angioplasty (PTCA) and stenting showed similar major complication rates to coronary artery bypass grafting (CABG) for multivessel coronary artery disease. CABG patients experienced more frequent arrhythmias, but overall outcomes were comparable.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Cardiac Surgery
Background:
- Existing research compares percutaneous transluminal coronary angioplasty (PTCA) and/or stent placement with coronary artery bypass grafting (CABG) for safety and outcomes.
- Limited data exists on these procedures specifically within Puerto Rico.
Purpose of the Study:
- To examine clinical characteristics, risk factors, indications, and post-intervention complications.
- To compare outcomes of multivessel coronary artery disease (CAD) patients undergoing PTCA/stenting versus isolated CABG.
Main Methods:
- Retrospective analysis of clinical, angiographic, and procedural data from January 1998 to August 1998.
- 53 patients in the PTCA/stent group and 206 in the CABG group.
- Statistical comparison using Student t-test, Mann-Whitney-Wilcoxon, Pearson's chi-square, and Fisher's exact tests.
Main Results:
- No significant differences in age, body surface area, or cardiac risk factors between groups.
- PTCA/stent group predominantly had two-vessel disease without left anterior descending obstruction; CABG group more commonly had three-vessel disease.
- CABG group had a higher frequency of overall complications and atrial arrhythmias, but major complication incidence was not statistically different.
Conclusions:
- PTCA/stenting and CABG demonstrated comparable rates of major complications for multivessel CAD.
- Further prospective studies are recommended to confirm these preliminary findings and address identified issues.
Objective:
This study examined the clinical characteristics, risk factors, indications and post-intervention complications of patients with multivessel coronary artery disease (CAD) submitted to either percutaneous transluminal coronary angioplasty (PTCA) and/or stent placement versus isolated coronary artery bypass grafting (CABG).
Background:
Several studies have examined the relative safety and outcome of patients submitted to those interventional procedures compared to CABG. Limited information is available regarding that subject in Puerto Rico.
Methods:
We performed a retrospective analysis of the clinical, angiographic, operative, interventional, post-operative and post-interventional data of patients submitted to those procedures in our institution from January 1998 to August 1998. There were 53 patients in the interventional group and 206 patients in the CAGB group. Comparison of quantitative variables by procedure was based on Student t test or Mann-Whitney-Wilcoxon test; categorical variables were compared using Pearson's chi-square or Fisher's exact test.
Results:
There were no significant differences in age, body surface area, or cardiac risk factors. The most common pre-existing cardiovascular diagnosis was unstable angina. Three-vessel disease was the most common angiographic finding among CABG patients (61.7%). Two-vessel disease without left anterior descending coronary artery obstruction was significantly more common in the PTCA/Stent patients (58.5%). The vast majority (97.6%) of patients in the PTCA/Stent group and 52.4% of the CABG group had two-vessel intervention. A significantly higher frequency of complications occurred in the CABG group. However, the incidence of major complications, in both groups was not statistically different. Atrial arrhythmias were significantly more frequent in the CABG group.
Conclusion:
A larger prospective study should be conducted in order to corroborate these preliminary findings and seek effective solution to any identifiable problem.