Long-term outcomes of myocardial revascularization in patients with multivessel coronary artery disease and comorbid pathology

Madiyeva M.I. Aripov M.A. Goncharov A.Y. Мansurova J.A.
2024 National Scientific Medical Center

Journal of Clinical Medicine of Kazakhstan
2024 #21 Issue 2 47 - 54 pp.

Objective. To assess the long-term outcomes of myocardial revascularization in patients with multivessel coronary artery disease and varying degrees of comorbidity. Materials and methods. 406 patients with low and moderate Syntax scores (SS) (<33) underwent primary percutaneous coronary intervention (PCI) (n=200) with a drug-eluting stent, and coronary artery bypass grafting (CABG) (n=206). Patients were stratified by the Charlson Comorbidity Index (CCI) into 2 groups: 1) CCI ≤ 3(n=108/26.6%); 2) CCI ≥ 4(n=298/73.4%). 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, decreased left ventricular ejection fraction, and high SS in dynamics. Results. An increase in CCI of more than 4 points was significantly associated with the risk of developing a combination of MACCE (HR 1.3, 95% CI 1.2 – 1.4, p<0.001), all-cause mortality (HR 1.25, 95% CI 1.2 – 1.4, p<0.001), and cerebrovascular accidents (CVA) (HR 2.2, 95% CI 1.4 – 3.4, p=0.001). Patients with CCI ≥4 required repeat revascularization more frequently after PCI than after CABG (HR 2.6, 95% CI 1.8 – 3.7, p<0.001). Among patients with varying degrees of comorbidity, the risk of progression of coronary atherosclerosis (SS≥33) was higher after CABG compared with PCI. Conclusion. A CCI score of more than 4 points was associated with an increased risk of developing of MACCE, all-cause mortality, and CVA. Among patients with varying degrees of comorbidity, PCI and CABG did not demonstrate significant advantages in terms of MACCE.

Comorbidity , Coronary Artery Bypass Grafting , Coronary Artery Disease , Percutaneous Coronary Intervention

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Department of Emergency cardiology, Pavlodar Regional Cardiology Center, Pavlodar, Kazakhstan
Department of Interventional Cardiology, National Research Cardiac Surgery Center, Astana, Kazakhstan
Department of Therapy, Semey Medical University, Semey, Kazakhstan

Department of Emergency cardiology
Department of Interventional Cardiology
Department of Therapy

10 лет помогаем публиковать статьи Международный издатель

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