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A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
[Coronary stenting in patients with ischemic heart disease with multivessel involvement of coronary vascular bed and
Insights
For ischemic heart disease patients with multivessel coronary artery disease, drug-eluting stent percutaneous coronary intervention shows comparable outcomes to coronary artery bypass grafting, offering a viable alternative revascularization strategy.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Ischemic heart disease (IHD) with multivessel coronary artery involvement necessitates revascularization.
- Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are primary revascularization strategies.
- Comparing long-term outcomes of CABG versus PCI with drug-eluting stents (DES) is crucial for treatment decisions.
Purpose of the Study:
- To compare the efficacy and safety of CABG versus multivessel PCI with DES in patients with IHD and multivessel coronary artery disease.
- To evaluate immediate and long-term (5-year) clinical outcomes, including survival, angina recurrence, and major adverse cardiovascular events.
Main Methods:
- A prospective study followed 619 patients with IHD and multivessel coronary artery disease.
- Patients were randomized to either CABG (317 patients) or multivessel PCI with DES (302 patients).
- Outcomes assessed included in-hospital events, survival, angina recurrence, repeat revascularization, and a composite of major adverse cardiovascular events up to 5 years.
Main Results:
- No significant differences in in-hospital death, myocardial infarction, or stroke rates between CABG and PCI groups.
- Long-term survival rates were similar: 90.2% for CABG and 92.7% for PCI.
- While angina recurrence and repeat revascularization rates were comparable, the rate of repeat revascularization was significantly higher after PCI (90.6%) compared to CABG (59.3%).
- Overall severe unfavorable event rates were not significantly different between the groups (33.1% for CABG vs. 30.5% for PCI).
Conclusions:
- In patients with IHD, multivessel coronary artery involvement, and low Syntax Score, multivessel PCI with DES demonstrates non-inferiority to CABG in terms of immediate and long-term (5-year) results.
- Drug-eluting stent PCI represents a safe and effective alternative to CABG for selected IHD patients.
- Treatment decisions should consider patient-specific factors and procedural risks.
Material And Methods:
We followed 619 patients with ischemic heart disease (IHD) and multivessel involvement of coronary arteries: 317 patients subjected to coronary artery bypass grafting (CABG, group 1) and 302 patients subjected to multivessel percutaneous coronary intervention (PCI, group 2) with implantation of drug eluting stents. Both groups had comparable clinical characteristics. During hospitalization we registered deaths and unfavorable cardiological and cerebrovascular events. In remote period after revascularization we assessed survival, angina recurrences and related repeat revascularizations, and rate of severe cardiovascular complications (composite of deaths, acute myocardial infarctions [AMI], stroke, and repeat myocardial revascularizations).
Results:
During hospitalization there were no significant differences between groups by parameters studied: death rate was 1.7 and 0.9%, that of AMI 2.6 and 1.9%, of stroke 0.9% and 0, of composite of death, AMI, and stroke 5.1 and 1.9% (p = 0.37) in groups 1 and 2, respectively. Survival in remote period was 90.2 (group 1) and 92.7% (group 2). Comparison of Kaplan-Meier survival curves also revealed no significant differences between groups. Angina recurrence/repeat revascularization took place in 54 (17.0%) and in 64 (21.2%) patients in groups 1 and 2, respectively (p = 0.128). Repeat revascularization was carried out in 32 of 54 patients (59.3%) in group 1 and in 58 Of 64 patients (90.6%) in group 2. Rate of severe unfavorable events during whole period of follow up was 33.1% in group 1 and 30.5% in group 2 (p > 0.05).
Conclusion:
In IHD patients with multivessel coronary artery involvement and low Syntax Score immediate and long term (5 year) results of stenting with drug eluting stents are not inferior to results of CABG.
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