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Revascularization Versus Medical Therapy in Takayasu's Arteritis Patients with Coronary Artery Involvement

Zhiwei Huang1, Hongliang Zhang1, Man Wang1

  • 1Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China.

Rheumatology and Therapy
|November 24, 2020
PubMed

Insights

For Takayasu's arteritis (TA) patients with coronary lesions, revascularization and medical therapy show similar cardiovascular death rates. Percutaneous coronary intervention (PCI) has higher restenosis than coronary artery bypass grafting (CABG).

Area of Science:

  • Cardiovascular Medicine
  • Rheumatology
  • Interventional Cardiology

Background:

  • Takayasu's arteritis (TA) can cause coronary artery lesions, necessitating treatment strategies.
  • Current therapeutic approaches for TA with coronary involvement, including medical therapy and revascularization, lack clear guidance.

Purpose of the Study:

  • To investigate the clinical characteristics of TA patients with coronary lesions.
  • To compare the outcomes of revascularization versus medical therapy in these patients.

Main Methods:

  • Retrospective analysis of 806 TA patients from January 2008 to December 2019.
  • Categorization into medical treatment and revascularization groups (PCI and CABG).
  • Comparison of cardiovascular death and restenosis rates between treatment groups.

Main Results:

  • Ninety TA patients with coronary lesions were analyzed; 39 received medical treatment, and 51 underwent revascularization (28 PCI, 23 CABG).
  • No significant difference in cardiovascular death between medical treatment and revascularization groups (5.1% vs. 9.8%).
  • Higher restenosis rates observed in PCI compared to CABG (39.3% vs. 8.7%), with similar cardiovascular mortality between PCI and CABG subgroups.

Conclusions:

  • Medical therapy and revascularization demonstrate comparable cardiovascular mortality in TA patients with coronary lesions.
  • While cardiovascular death rates are similar between PCI and CABG, PCI is associated with significantly higher restenosis rates.
  • Heart failure is identified as an independent predictor of mortality in this patient population.
Abstract

Keywords:
Coronary artery bypass surgeryCoronary artery involvementMedical treatmentPercutaneous coronary interventionTakayasu's arteritis

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