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

[摘要] 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).

[学科分类] 医学（综合）

[关键词] coronary artery disease;coronary artery bypass grafting;percutaneous coronary intervention;SYNTAX score