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Published on: March 27, 2018
Long-term results of myocardial revascularization in patients with multivessel disease
Insights
Coronary artery bypass grafting (CABG) is superior to percutaneous coronary intervention (PCI) with drug-eluting stents for intermediate SYNTAX scores, showing fewer repeat revascularizations over 9 years.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Surgery
Background:
- The optimal revascularization strategy for multivessel coronary artery disease remains a subject of debate.
- Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are the primary treatment options.
- Drug-eluting stents (DES) have improved PCI outcomes, but comparisons with CABG persist.
Purpose of the Study:
- To compare the long-term efficacy and safety of CABG versus PCI with DES in patients with multivessel disease.
- To evaluate outcomes based on SYNTAX score (SS) stratification.
- To assess major adverse cardiac and cerebrovascular events (MACCE), repeat revascularization (RR), left ventricular ejection fraction (LVEF), and SYNTAX score changes.
Main Methods:
- A prospective study included 406 patients with multivessel disease undergoing either PCI with DES (n=200) or CABG (n=206).
- Patients were stratified by SYNTAX score (SS ≤ 22 or SS 23-32).
- Follow-up averaged 9±1.9 years, monitoring MACCE, RR, LVEF, and SS dynamics.
Main Results:
- Patients with intermediate SS (23-32) required significantly more RR after PCI than CABG (64% vs 22.6%).
- No significant differences in overall MACCE were observed between PCI and CABG groups.
- A greater decrease in LVEF was noted in the low SS subgroup after CABG compared to PCI (39.5% vs 27.7%).
Conclusions:
- CABG demonstrated an advantage over PCI with DES in intermediate SS patients regarding MACCE, primarily due to a lower RR rate.
- The CABG group experienced more significant atherosclerosis progression and a higher incidence of heart failure.
- Long-term data suggests CABG may be preferable for certain patient subsets with multivessel disease.
Background:
Choosing the method of revascularization - coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) - remains debatable.
Methods:
We selected 406 patients with multivessel disease who underwent PCI with a drug-eluting stent (DES) (n = 200, 100 with a SYNTAX score (SS) ≤ 22 and 100 with a SS 23-32); and CABG (n = 206, 100 with a SS ≤ 22 and 106 with a SS 23-32). The mean follow-up period was 9±1.9 years. The endpoints of the study were as follows: major adverse cardiac and cerebrovascular events (МАССЕ), a repeat revascularization (RR), diminished left ventricular ejection fraction (LVEF), and high SS in dynamics.
Results:
Patients with an intermediate SS needed RR more often with PCI than after CABG (64 % vs 22.6 %; HR: 3.52; CI: 2.19-5.66; р < 0.001). We found no significant differences for other MACCE between the groups. The decrease in LVEF was greater in the low SS subgroup in operated patients than after PCI (39.5 % vs 27.7 %; HR: 0.57; CI: 0.34-0.98; p = 0.04). The difference between the initial and final SS, was greater after the CABG than after PCI (43.5 % vs 10.9 %; HR: 0.26; CI: 0.14-0.47; р < 0.001).
Conclusions:
After 9 ± 1.9 years in intermediate SS group CABG exhibited an advantage over PCI with DES in terms of the MACCE indicators due to a smaller number of RR in the CABG group. The CABG group showed a more significant progression of atherosclerosis, and more heart failure cases (Tab. 2, Fig. 4, Ref. 29). Text in PDF www.elis.sk Keywords: coronary artery disease, coronary artery bypass grafting, percutaneous coronary intervention, SYNTAX score.
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