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Percutaneous Coronary Intervention VersusMyocardial Revascularization Surgery inMultivessel Coronary Artery Disease:
Adrián Naranjo-Domínguez1, Ronald Aroche-Aportela2, Myder Hernández-Navas2
1Cardiology and Cardiovascular Surgery Institute, Havana, Cuba.
Insights
Myocardial revascularization surgery provides better survival rates than percutaneous coronary intervention for multivessel coronary artery disease. Patients undergoing interventionism experienced more adverse events, often requiring repeat procedures.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Ischemic heart disease caused 29,939 deaths in Cuba in 2020.
- Multivessel coronary artery disease (CAD) is commonly treated with myocardial revascularization surgery (MRS) or percutaneous coronary intervention (PCI).
- Optimal treatment strategy for left main coronary ischemia remains debated.
Purpose of the Study:
- To compare survival and major adverse cardiac and cerebrovascular events (MACCE) between PCI and MRS in patients with multivessel CAD.
- To analyze the relationship between treatment outcomes and patient clinical/angiographic characteristics.
Main Methods:
- Retrospective cohort study of 41 patients (40-85 years) with multivessel CAD treated with PCI (n=17) or MRS (n=24) in 2016.
- Follow-up for MACCE over four years.
- Kaplan-Meier survival analysis and log-rank tests for comparison; Cox proportional hazards model for hazard ratios.
Main Results:
- 20 MACCE occurred: 15 in PCI group (75%) and 5 in MRS group (5%).
- Survival probability was 70.6% for MRS versus 37.5% for PCI (p=0.043).
- Repeat revascularization was significantly more frequent after PCI (log-rank p=0.015).
Conclusions:
- Myocardial revascularization surgery demonstrates superior survival rates compared to percutaneous coronary intervention.
- PCI is associated with a higher incidence of MACCE, primarily driven by the need for repeat revascularization procedures.
Introduction:
In Cuba, 29,939 deaths from ischemic heart disease were recorded in 2020. Myocardial revascularization surgery and percutaneous coronary intervention are well-established methods of treating patients with multivessel coronary artery disease. These methods can reduce overall deaths, but choosing the optimal strategy for treating left main coronary ischemia is a source of debate among specialists.
Objective:
Estimate survival and major cardiac and cerebrovascular events in patients treated with percutaneous coronary intervention versus myocardial revascularization surgery and their relationships with pre-existing patients' clinical and angiographic characteristics.
Methods:
We conducted a retrospective cohort study in 41 patients; 35 men and 6 women aged 40-85 years who had been diagnosed with multivessel coronary artery disease and treated with percutaneous coronary intervention (n = 17) or myocardial revascularization surgery (n = 24) at the Medical-Surgical Research Center in Havana, Cuba, in 2016. The main variable under consideration was the occurrence of major adverse cardiovascular events over a four-year period following these interventions. We collected clinical and angiographic characteristics, and used the Kaplan-Meier test to calculate survival curves. Survival probabilities were compared using the log-rank test. A value of p ⟨ 0.05 was considered statistically significant. The Cox proportional hazards model was used to estimate the hazard ratio, with 95% confidence intervals used for both procedures.
Results:
There were a total of 20 major adverse cardiovascular events, 75% (15/20) of which occurred in patients who underwent percutaneous coronary intervention and 5% in patients who had myocardial revascularization surgery. The probability of survival was 70.6% in surgery and 37.5% in interventionism; p = 0.043; hazard ratio 1.58 (95% confidence interval 0.987-2.530), p = 0.047. The need to repeat a revascularization procedure was the only major cardiovascular event that showed significant differences between methods (log-rank p = 0.015), and was more frequent in percutaneous intervention.
Conclusions:
Myocardial revascularization surgery offers a better chance of survival than percutaneous coronary intervention. Major adverse cardiovascular events are more frequent in patients with coronary interventionism, due to the need to repeat revascularization.
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