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Published on: September 15, 2023
Survival of patients with well-developed collaterals undergoing CABG or medical treatment: an observational
Ersan Tatlı1, Meryem Aktoz, Mehmet Akif Çakar
1Clinic of Cardiology, Ada Tıp Hospital, Sakarya-Turkey. ersantatli@yahoo.com
Insights
Coronary artery bypass grafting (CABG) showed no significant survival benefit in patients with well-developed coronary collaterals compared to medical treatment. Outcomes like angina and heart attack rates were similar between groups.
Area of Science:
- Cardiology
- Cardiovascular Surgery
Background:
- Coronary artery bypass grafting (CABG) is a common treatment for coronary artery disease.
- Its effectiveness in patients with well-developed coronary collaterals, who may have alternative blood supply, is not well-established.
Purpose of the Study:
- To evaluate the impact of CABG on mortality and other clinical outcomes in patients with critical left anterior descending artery occlusion and well-developed collateral circulation.
- To compare survival rates, angina, and myocardial infarction incidence between patients who underwent CABG and those who received medical treatment.
Main Methods:
- Retrospective observational case-controlled study of 78 patients with critical LAD occlusion and Rentrop-3 collateral circulation.
- Patients were divided into two groups: CABG (n=40) and medical treatment (n=38).
- Evaluated survival, angina pectoris, acute myocardial infarction, and functional capacity (NYHA). Survival analysis used Kaplan-Meier.
Main Results:
- No significant differences were found in baseline characteristics, angina presence/severity, myocardial infarction, stroke, or functional capacity between CABG and medical treatment groups.
- Cardiovascular death occurred in 8 patients (CABG) and 5 patients (medical treatment) (p=0.710).
- 5-year survival rates were 80% for CABG and 84% for medical treatment (p=0.730).
Conclusions:
- Well-developed coronary collaterals may provide sufficient blood supply, rendering CABG unnecessary for improving survival in selected patients.
- CABG did not demonstrate a significant survival advantage over medical treatment in this specific patient cohort.
Objective:
The effects of coronary artery bypass grafting (CABG) on mortality have not been evaluated in patients with well-developed coronary collaterals. We investigated functional capacity, presence of angina, the occurrence of acute myocardial infarction, survival and mortality in patients with well-developed coronary collaterals both undergoing and refusing CABG.
Methods:
The study was designed as a retrospective observational case-controlled study. Seventy-eight patients undergoing coronary angiography were included in this study. They had critical occlusion in the proximal left anterior descending artery (LAD) with Rentrop-3 collateral circulation towards LAD, and to proceed with CABG has been suggested. The patients were divided in two groups; first group proceeding with CABG (n=40) and the second, rejecting the surgery (medical treatment group; n=38). The rates of survival, the incidence of angina pectoris and acute myocardial infarction as well as the functional capacities were evaluated in all patients. Survival rates were evaluated using Kaplan-Meier survival analysis.
Results:
No statistically significant difference was observed between the two groups regarding the baseline characteristics of patients, the presence of angina pectoris, the severity of angina pectoris according to CCS, the occurrence of acute myocardial infarction or stroke, and the functional capacity according to NYHA (p>0.05). Death due to cardiovascular reasons was observed in eight patients of CABG group and in five patients of medical treatment group (p=0.710). The 5-year survival rate was observed to be 80% in CABG group while it was observed to be 84% in the medical treatment group (p=0.730).
Conclusion:
There was no significant difference regarding the survival rates in patients with well-developed coronary collaterals proceeding with CABG or medical treatment.
