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[Survival of patients with triple-vessel stenosing coronary atheroma]
Insights
This study tracked 179 triple vessel coronary artery disease patients, finding overall survival rates of 89% at 1 year and 71% at 6 years. Cardiac failure significantly impacted survival, with lower mortality in surgical patients.
Area of Science:
- Cardiology
- Vascular Surgery
- Clinical Outcomes Research
Background:
- Triple vessel coronary artery disease (TV-CAD) poses significant mortality risks.
- Understanding long-term survival in TV-CAD patients is crucial for treatment planning.
Purpose of the Study:
- To analyze the survival rates of patients with triple vessel coronary artery disease.
- To compare outcomes between medical and surgical management.
- To identify factors influencing mortality in this patient cohort.
Main Methods:
- A cohort of 179 TV-CAD patients (excluding left main stem disease) was studied.
- Patients received either coronary bypass surgery (34%) or medical therapy.
- Survival was assessed via questionnaires sent to patients and physicians, with 100% response rate.
- Actuarial methods and Log-Rank tests were used for survival analysis.
Main Results:
- Overall survival rates were 89% at 1 year, 84% at 2 years, 82% at 5 years, and 71% at 6 years.
- Patients with cardiac failure had a significantly lower 2-year survival rate (40%) compared to those without (88%).
- Mortality was higher (33% at 4 years) when TV-CAD was discovered during myocardial infarction.
Conclusions:
- Triple vessel coronary artery disease patients have a guarded prognosis, especially those with cardiac failure.
- Surgical intervention may be associated with lower mortality, though not statistically significant in this study.
- Early detection and management of cardiac failure are critical for improving survival in TV-CAD patients.
Abstract:
This study analysed the survival rate of 179 patients with triple vessel coronary artery disease, 168 men and 11 women (mean age 54 years). Seventeen cases of left main stem disease were excluded. The patients presented with unstable angina (64 cases), stable angina (66 cases), recent myocardial infarction (26 cases) or chronic invalidating angina (23 cases). Coronary bypass surgery was undertaken whenever possible (64 cases, 34% of patients). Medical therapy (115 cases) was based on betablockers (61%), amiodarone (22%) and perhexiline (17%). The study was carried out by a double questionnaire sent to the patient and treating physician, 6 months to 76 months after coronary angiography (average 30 months). The response to these questionnaires was 100%. Survival rates were calculated by actuarial methods. Comparisons of survival graphs was made using the Log Rang test. The overall survival rate was 89% at 1 year, 84% at 2 years, 82% at 5 years and 71% at 6 years. There seemed to be a lower mortality in the surgical group (p less than 0,28). The 2 year survival rate in the group with cardiac failure was 40% compared with 88% in the group without cardiac failure (p less than 0,001). There was no statistically significant difference in mortality except in patients with ejection fractions lower than 0,30. Analysis of survival with respect to mode of presentation did not show any significant difference between patients with unstable angina, stable angina or chronic invalidating angina. Mortality was higher when triple vessel disease was discovered during myocardial infarction, reaching 33% at 4 years, compared to 15% in the other subgroups (p less than 0,05).(ABSTRACT TRUNCATED AT 250 WORDS)