[Different approaches to revascularization for complex coronary artery disease and left ventricular dysfunction:
Lei-Lei Shen1, Rong Wang, Chang-Qing Gao
1Department of Cardiovascular Surgery, General Hospital of PLA, Beijing 100853, China.E-mail: justshenleilei@163.com.
Insights
Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are safe for complex coronary artery disease with left ventricular dysfunction. CABG offers more complete revascularization and better left ventricular function improvement.
Area of Science:
- Cardiology
- Cardiac Surgery
- Interventional Cardiology
Background:
- Complex coronary artery disease (CAD) with left ventricular dysfunction (LVD) presents a significant therapeutic challenge.
- Evaluating revascularization strategies is crucial for optimizing patient outcomes.
Purpose of the Study:
- To compare perioperative outcomes of coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI).
- To assess efficacy in patients with complex CAD and LVD (ejection fraction ≤50%).
Main Methods:
- Retrospective review of 966 patients (2003-2013) with CAD and LVD.
- Matched analysis of 135 CABG patients and 135 PCI patients based on risk factors and echocardiographic parameters.
- Evaluation of hospital mortality, major complications, and changes in left ventricular geometry and function.
Main Results:
- No significant difference in hospital mortality or major perioperative complications between CABG and PCI.
- CABG group achieved higher rates of complete revascularization (94.8% vs 51.8%).
- Both procedures showed similar perioperative changes in left ventricular ejection fraction (LVEF), but CABG had greater variation in left ventricular end-diastolic diameter (LVEDD).
Conclusions:
- Both CABG and PCI are safe and effective revascularization strategies for complex CAD with LVD.
- CABG demonstrates superiority in achieving complete revascularization and enhancing left ventricular function.
- The choice between CABG and PCI should consider individual patient factors and treatment goals.
Objective:
To compare the perioperative outcomes of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) for treatment of complex coronary artery disease and left ventricular dysfunction.
Methdos:
The clinical data of 966 patients admitted to our hospital from January 2003 to December 2013 with coronary artery disease and left ventricular dysfunction (ejection fraction ≤50%) were retrospectively reviewed. Among the patients, 386 underwent CABG and 580 received PCI. After matching for EuroSCORE risk factors and preoperative echocardiographic parameters, 135 patients with CABG and 135 with PCI were enrolled in this study. With hospital mortality and perioperative major complications as the endpoints, the early outcomes of the procedures were evaluated. Perioperative echocardiography was performed to evaluate the change of left ventricular geometry and function.
Results:
Compared with CABG group, PCI group had significantly higher incidences of chronic lung disease (8.1% vs 0.7%, P=0.003) and recent myocardial infarction (64.4% vs 31.9%, P=0.000) but significantly lower left-main disease (12.6% vs 23.7%, P=0.018); the other baseline characteristics were comparable between the two groups. Patients with CABG had a greater number of treated target vessels than those with PCI (2.90±0.81 vs 1.67±0.73, P=0.000), and complete revascularization was more common in CABG group (94.8% vs 51.8%, P=0.000). No significant difference was found in perioperative variations of LVEF between the two groups, but patients with CABG had a greater variation in LVEDD than those with PCI. The hospital mortality and other major complications were similar between the two groups.
Conclusion:
Both CABG and PCI are safe and reliable revascularization strategies for complex coronary artery disease and left ventricular dysfunction, but CABG can achieve a higher rate of complete revascularization and better improves the left ventricular function.
More Related Videos
Related Concept Videos
01:27Coronary Artery Disease V: Interprofessional Care
01:29Cardiomyopathy V: Interprofessional Care
01:24Cardiac Catheterization III: Left Heart Catheterization
01:25Aortic Regurgitation III: Medical Management
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:21Coronary Circulation
Coronary circulation begins at the base of the aorta, where two main arteries arise—the left and right coronary arteries. These arteries encircle the heart in the coronary sulcus and supply the...