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[Long-term results of different approaches to revascularization in non-ST-segment elevation acute coronary syndrome
V I Ganyukov1, R S Tarasov1, Yu N Neverova1
1Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia.
Insights
For patients with non-ST-segment elevation acute coronary syndrome and multivessel coronary artery disease, coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) show comparable long-term survival. Medical treatment alone yielded the worst outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Non-ST-segment elevation acute coronary syndrome (NSTE ACS) with multivessel coronary artery disease (MVCAD) presents complex treatment challenges.
- Optimal revascularization strategies are crucial for improving patient outcomes.
Purpose of the Study:
- To compare the long-term results of percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), and medical management in patients with NSTE ACS and MVCAD.
Main Methods:
- A study involving 150 patients with NSTE ACS and MVCAD.
- Patients were allocated to PCI (n=91), CABG (n=40), or medical treatment (n=9).
- Mean follow-up duration was 27.6 months.
Main Results:
- Medical treatment alone resulted in the poorest outcomes, with most events occurring during hospitalization.
- Percutaneous coronary intervention (PCI) had limitations, leading to suboptimal results in this patient cohort.
- Coronary artery bypass grafting (CABG) and PCI demonstrated comparable survival rates.
Conclusions:
- Both CABG and PCI are effective myocardial revascularization techniques for NSTE ACS and MVCAD, offering satisfactory survival.
- A significant minority (12%) were deemed too high-risk for revascularization, experiencing high mortality, primarily in-hospital.
Aim:
To assess the long-term results of different approaches to treating patients with non-ST-segment elevation acute coronary syndrome (NSTE ACS) and multivessel coronary artery disease (MVCAD).
Subjects And Methods:
A total of 150 patients with NSTE ACS, in whom coronary angiography revealed MVCAD, were examined. The patients were divided into 3 groups according to the selected treatment policy: 1) percutaneous coronary intervention (PCI) (n=91 (60.6%)); 2) coronary artery bypass grafting (CABG) (n=40 (26.6%)); and 3) only medical treatment (n=9 (6%)). The mean follow-up was 27.6±3.5 months.
Results:
The medical treatment policy in this patient sample demonstrates the worst results, with the majority of cardiovascular events developing in the hospital period. PCI in patients with NSTE ACS and multiple coronary atherosclerosis has a number of objective limitations in this patient sample, leading to suboptimal treatment outcome.
Conclusion:
The use of CABG or PCI as a myocardial revascularization technique in patients with NSTE ACS and MVCAD is characterized by a comparable satisfactory survival in the hospital and long-term follow-up periods. 12% of patients do not receive revascularization due to the extremely high risk from any of coronary blood restoring methods, which results in very many deaths largely occurring during the hospital period.
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