Document Type : Original Article(s)
Authors
- Alireza Khosravi 1
- Mehrbod Vakhshoori 2
- Vahid Sharif 3
- Farshad Roghani-Dehkordi 4
- Jamshid Najafian 5
- Asieh Mansouri 6
1 Professor, Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
2 Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
3 Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
4 Professor, Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
5 Associate Professor, Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
6 Assistant Professor, Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
BACKGROUND: The probable complications of 3 different cardiovascular diseases treatment options including percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG), and medical therapy (MT), especially in individuals suffering from left main (LM) and/or three vessel diseases (3VDs), have received less attention. Thus, the aim of this study was to compare the complications of the aforementioned therapeutic strategies in patients admitted with LM coronary artery disease (CAD) and/or having 3VDs.METHODS: From March 2018 to March 2019, a total number of 251 eligible individuals (87, 86, and 78 subjects treated with PCI, CABG, and MT, respectively) were recruited in this cohort study. After the initiation of treatment, all individuals were followed for 6 months. Occurrence of any complications including chest pain (CP), re-hospitalization due to cardiac problems, heart failure (HF), death, myocardial infarction (MI), and stroke as well as major adverse cardiac events (MACE) were assessed.RESULTS: Significantly lower percentages of CP, readmission, and HF were observed in the CABG group compared to the PCI and MT groups (24.4% vs. 47.1% and 53.9%, P < 0.001; 3.5% vs. 13.8% and 5.1%, P = 0.020; 1.2% vs. 2.3% and 9%; P = 0.040, respectively). Further analysis revealed an increased likelihood of hospitalization in the PCI group (OR: 3.82, 95% CI: 1.01-14.41, P = 0.040), and a lower risk of CP and HF occurrence in the CABG group subjects compared to the MT group (OR: 0.28, 95% CI: 0.13-0.62, P = 0.002 and OR: 0.05, 95% CI: 0.004-0.71, P = 0.030, respectively). This pattern was also observed in the PCI group in terms of HF (OR: 0.12, 95% CI: 0.02-0.83, P = 0.030).CONCLUSION: Patients suffering from LM and/or 3VDs would most likely benefit from CABG followed by PCI, rather than MT. Further large-scale studies are required to confirm these results.
Keywords
- Mercado N, Wijns W, Serruys PW, Sigwart U, Flather MD, Stables RH, et al. One-year outcomes of coronary artery bypass graft surgery versus percutaneous coronary intervention with multiple stenting for multisystem disease: A meta-analysis of individual patient data from randomized clinical trials. J Thorac Cardiovasc Surg 2005; 130(2): 512-9.
- Alaei Faradonbeh N, Nikaeen F, Akbari M, Almasi N, Vakhshoori M. Cardiovascular disease risk prediction among Iranian patients with diabetes mellitus in Isfahan Province, Iran, in 2014, by
- using Framingham risk score, atherosclerotic cardiovascular disease risk score, and high-sensitive C-reactive protein. ARYA Atheroscler 2018; 14(4): 163-8.
- Mueller RL, Sanborn TA. The history of interventional cardiology: Cardiac catheterization, angioplasty, and related interventions. Am Heart J 1995; 129(1): 146-72.
- Favaloro RG. Saphenous vein autograft replacement of severe segmental coronary artery occlusion: Operative technique. Ann Thorac Surg 1968; 5(4): 334-9.
- Gruntzig AR, Senning A, Siegenthaler WE. Nonoperative dilatation of coronary-artery stenosis: Percutaneous transluminal coronary angioplasty. N Engl J Med 1979; 301(2): 61-8.
- Chaitman BR, Fisher LD, Bourassa MG, Davis K, Rogers WJ, Maynard C, et al. Effect of coronary bypass surgery on survival patterns in subsets of patients with left main coronary artery disease. Report of the Collaborative Study in Coronary Artery Surgery (CASS). Am J Cardiol 1981; 48(4): 765-77.
- Caracciolo EA, Davis KB, Sopko G, Kaiser GC, Corley SD, Schaff H, et al. Comparison of surgical and medical group survival in patients with left main equivalent coronary artery disease. Long-term CASS experience. Circulation 1995; 91(9): 2335-44.
- Wang Z, Zhan B, Bao H, Huang X, Wu Y, Liang Q, et al. Percutaneous coronary intervention versus coronary artery bypass grafting in unprotected left main coronary artery stenosis. Am J Med Sci 2019; 357(3): 230-41.
- Wei Z, Xie J, Wang K, Kang L, Dai Q, Bai J, et al. Comparison of percutaneous coronary intervention versus coronary artery bypass graft in aged patients with unprotected left main artery lesions. Int Heart
- J 2016; 57(6): 682-8.
- Mohr FW, Morice MC, Kappetein AP, Feldman TE, Stahle E, Colombo A, et al. Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial. Lancet 2013; 381(9867): 629-38.
- Deo SV, Sharma V, Shah IK, Erwin PJ, Joyce LD, Park SJ. Minimally invasive direct coronary artery bypass graft surgery or percutaneous coronary intervention for proximal left anterior descending artery stenosis: A meta-analysis. Ann Thorac Surg 2014; 97(6): 2056-65.
- Kulik A. Quality of life after coronary artery bypass graft surgery versus percutaneous coronary intervention: What do the trials tell us? Curr Opin Cardiol 2017; 32(6): 707-14.
- Palmerini T, Biondi-Zoccai G, Reggiani LB, Sangiorgi D, Alessi L, De Servi S, et al. Risk of stroke with coronary artery bypass graft surgery compared with percutaneous coronary intervention. J Am Coll Cardiol 2012; 60(9): 798-805.
- Kimura T, Morimoto T, Furukawa Y, Nakagawa Y, Shizuta S, Ehara N, et al. Long-term outcomes of coronary-artery bypass graft surgery versus percutaneous coronary intervention for multivessel coronary artery disease in the bare-metal stent era. Circulation 2008; 118(14 Suppl): S199-S209.
- Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J 2019; 40(2): 87-165.
- Capodanno D, Stone GW, Morice MC, Bass TA, Tamburino C. Percutaneous coronary intervention versus coronary artery bypass graft surgery in left main coronary artery disease: A meta-analysis of randomized clinical data. J Am Coll Cardiol 2011; 58(14): 1426-32.
- Kurlansky P, Herbert M, Prince S, Mack M. Coronary artery bypass graft versus percutaneous coronary intervention: Meds matter: Impact of adherence to medical therapy on comparative outcomes. Circulation 2016; 134(17): 1238-46.
- Pursnani S, Korley F, Gopaul R, Kanade P, Chandra N, Shaw RE, et al. Percutaneous coronary intervention versus optimal medical therapy in stable coronary artery disease: A systematic review and meta-analysis of randomized clinical trials. Circ Cardiovasc Interv 2012; 5(4): 476-90.
- Yazdani-Bakhsh R, Javanbakht M, Sadeghi M, Mashayekhi A, Ghaderi H, Rabiei K. Comparison of health-related quality of life after percutaneous coronary intervention and coronary artery bypass surgery. ARYA Atheroscler 2016; 12(3): 124-31.
- Khosravi A, Pourmoghaddas M, Asadi K, Abdi A, Gholamrezaei A. Immediate results and six-month outcomes after percutaneous coronary intervention in a referral heart center in Isfahan, Iran. ARYA Atheroscler 2011; 7(1): 24-30.
)