Long-term results of myocardial revascularization in patients with multivessel disease

Madiyeva M.I. Aripov M.A. Pya Y.V. Goncharov A.Y. Shakirova G.N.
2023 Comenius University in Bratislava

Bratislava Medical Journal
2023 #124 Issue 3 212 - 220 pp.

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 signifi cant 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 fi nal 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 signifi cant progression of atherosclerosis, and more heart failure cases (Tab. 2, Fig. 4, Ref. 29)

coronary artery bypass grafting , coronary artery disease , percutaneous coronary intervention , SYNTAX score

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Department of Internal Diseases, Pavlodar Branch, Semey Medical University, Pavlodar, Kazakhstan
Department of Interventional Cardiology, National Research Cardiac Surgery Center, Astana, Kazakhstan
Department of Cardiac Surgery, National Research Cardiac Surgery Center, Astana, Kazakhstan
Pavlodar Regional Cardiology Center, Pavlodar, Kazakhstan

Department of Internal Diseases
Department of Interventional Cardiology
Department of Cardiac Surgery
Pavlodar Regional Cardiology Center

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