medigraphic.com
ISSN 1527-3172 (Electronic)

2022, Number 1

<< Back Next >>

MEDICC Review 2022; 24 (1)

Percutaneous coronary intervention versus myocardial revascularization surgery in multivessel coronary artery disease: Four-year followup

Naranjo-Domínguez A, Aroche-Aportela R, Hernández-Navas M, Aldama-Pérez LI, García-Hernández RA, Valdés-Martín A

Language: English
References: 12
Page: 40-43
PDF size: 173.26 Kb.


ABSTRACT

INTRODUCTION In Cuba, 29,939 deaths from ischemic heart disease were recorded in 2020. Myocardial revascularization surgery and percutaneous coronary intervention are well-established methods of treating patients with multivessel coronary artery disease. These methods can reduce overall deaths, but choosing the optimal strategy for treating left main coronary ischemia is a source of debate among specialists. OBJECTIVE Estimate survival and major cardiac and cerebrovascular events in patients treated with percutaneous coronary intervention versus myocardial revascularization surgery and their relationships with pre-existing patients’ clinical and angiographic characteristics. METHODS We conducted a retrospective cohort study in 41 patients; 35 men and 6 women aged 40–85 years who had been diagnosed with multivessel coronary artery disease and treated with percutaneous coronary intervention (n = 17) or myocardial revascularization surgery (n = 24) at the Medical–Surgical Research Center in Havana, Cuba, in 2016. The main variable under consideration was the occurrence of major adverse cardiovascular events over a four-year period following these interventions. We collected clinical and angiographic characteristics, and used the Kaplan–Meier test to calculate survival curves. Survival probabilities were compared using the log-rank test. A value of p <0.05 was considered statistically significant. The Cox proportional hazards model was used to estimate the hazard ratio, with 95% confidence intervals used for both procedures. RESULTS There were a total of 20 major adverse cardiovascular events, 75% (15/20) of which occurred in patients who underwent percutaneous coronary intervention and 5% in patients who had myocardial revascularization surgery. The probability of survival was 70.6% in surgery and 37.5% in interventionism; p = 0.043; hazard ratio 1.58 (95% confidence interval 0.987–2.530), p = 0.047. The need to repeat a revascularization procedure was the only major cardiovascular event that showed significant differences between methods (log-rank p = 0.015), and was more frequent in percutaneous intervention. CONCLUSIONS Myocardial revascularization surgery offers a better chance of survival than percutaneous coronary intervention. Major adverse cardiovascular events are more frequent in patients with coronary interventionism, due to the need to repeat revascularization.


REFERENCES

  1. National Health Statistics and Medical RecordsDivision (CU). Anuario Estadístico de Salud 2020[Internet]. Havana: Ministry of Public Health (CU); 2021 Apr [cited 2021 Sep 17]. 206 p. Available at:https://fi les.sld.cu/bvscuba/fi les/2021/08/Anuario-Estadistico-Espa%c3%b1ol-2020-Defi nitivo.pdf.Spanish.

  2. Lee PH, Park H, Lee JS, Lee SW, Lee CW.Meta-analysis comparing the risk of myocardialinfarction following coronary artery bypassgrafting versus percutaneous coronary interventionin patients with multivessel or left maincoronary artery disease. Am J Cardiol [Internet].2019 Sep 15 [cited 2021 Jul 3];124(6):842–50.Available at: https://www.ajconline.org/article/S0002-9149(19)30709-X/fulltext

  3. Thygesen K, Alpert JS, Jaff e AS, ChaitmanBR, Bax JJ, Morrow DA, et al. Fourth universaldefi nition of myocardial infarction (2018).Eur Heart J [Internet]. 2019 Jan 14 [cited 2021Jul 6];40(3):237–69. Available at: https://doi.org/10.1093/eurheartj/ehy462

  4. Naranjo-Domínguez N, Aroche Aportela R,Hernández Navas M, Aldama L, Valdés MartínAV, Vitón Castillo AA. Utilidad pronóstica del puntajeSYNTAX en pacientes con enfermedad coronariamultiarterial. Seguimiento de 4 años. RevCubana Cardiol Cir Cardiovasc [Internet]. 2021Jul 1 [cited 2021 Jul 6];27(3):1234. Availableat: http://www.revcardiologia.sld.cu/index.php/revcardiologia/article/view/1234. Spanish.

  5. Serruys PW, Morice M-C, Kappetein AP, ColomboA, Holmes DR, Mack MJ, et al. Percutaneous coronary intervention versus coronary-arterybypass grafting for severe coronary artery disease.N Engl J Med [Internet]. 2009 Mar 5 [cited2021 Apr 15];360(10):961–72. Available at:https://doi.org/10.1056/NEJMoa0804626

  6. Shah KS, Xu H, Matsouaka RA, Bhatt DL,Heidenreich PA, Hernández AF, et al. Heartfailure with preserved, borderline, and reducedejection fraction: 5-year outcomes. J Am CollCardiol [Internet]. 2017 Nov 14–21 [cited 2021Jul 6];70(20):2476–86. Available at: https://www.sciencedirect.com/science/article/pii/S0735109717397619

  7. Hlatky MA, Boothroyd DB, Bravata DM, BoersmaE, Booth J, Brooks MM, et al. Coronary arterybypass surgery compared with percutaneouscoronary interventions for multivessel disease:a collaborative analysis of individual patient datafrom ten randomised trials. Lancet [Internet].2009 Apr 6 [cited 2021 Apr 16];373(9670):1190–7. Available at: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60552-3/

  8. Mohr FW, Morice M-C, Kappetein AP, FeldmanTE, Ståhle E, Colombo A, et al. Coronary arterybypass graft surgery versus percutaneous coronaryintervention in patients with three-vesseldisease and left main coronary disease: 5-yearfollowup of the randomised, clinical SYNTAXtrial. Lancet [Internet]. 2013 Feb 23–Mar 1 [cited2021 Apr 15];381(9867):629–38. Available at:https://www.sciencedirect.com/science/article/pii/S0140673613601415

  9. Naranjo-Domínguez A, Aroche Aportela R,Hernández M, Obregón A, Aldama L. Variabilidadinterobservador del Score SYNTAX enpacientes con diagnóstico de enfermedad arterialcoronaria multivaso. Rev Cubana Cardiol CirCardiovasc [Internet]. 2018 Jun 4 [cited 2021 Jul6];24(2):141–54. Available at: http://www.revcardiologia.sld.cu/index.php/revcardiologia/article/view/761. Spanish.

  10. Thuijs DJFM, Kappetein AP, Serruys PW, MohrF-W, Morice M-C, Mack MJ, et al. Percutaneouscoronary intervention versus coronary arterybypass grafting in patients with three-vessel orleft main coronary artery disease: 10-year followupof the multicentre randomised controlledSYNTAX trial. Lancet [Internet]. 2019 Oct 12[cited 2021 Jul 6];394(10206):1325–34. Availableat: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31997-X/fulltext

  11. Aroche Aportela R, Navarro Rodríguez AY, GarcíaOrcid RA, Hernández Nava M, ObregónSantos AG, Aldama Pérez L. Efectividad de laintervención coronaria percutánea con stent liberadorde paclitaxel frente a stent convencional.Rev Cubana Cardiol Cir Cardiovasc [Internet].2020 Jul 1 [cited 2021 Jul 3];26(3):1011. Availableat: http://www.revcardiologia.sld.cu/index.php/revcardiologia/article/view/1011. Spanish.

  12. López Ramírez M, Nafeh Abi-Resk M, LeyvaQuert A, Gutiérrez Lípez A, Tamargo BarbeitoTO, López Ramírez D, et al. Intervencionismocoronario frente a cirugía de revascularizaciónmiocárdica en pacientes con enfermedad multivaso.Rev Cubana Cardiol Cir Cardiovasc [Internet].2017 Oct 27 [cited 2021 Jul 4];23(3):361–70.Available at: http://revcardiologia.sld.cu/index.php/revcardiologia/article/view/700. Spanish.




2020     |     www.medigraphic.com