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Long-term outcomes of patients with multivessel coronary artery disease presenting non-ST-segment elevation acute coronary syndromes.
Cardiol J. 2019; 26(2):157-168.CJ

Abstract

BACKGROUND

There is paucity of data concerning the optimal revascularization in patients with mul- tivessel coronary artery disease (CAD) presenting non-ST-segment elevation acute coronary syndrome (NSTE-ACS). The aim was to evaluate long-term outcomes of patients with multivessel CAD presenting NSTE-ACS depending on the management after coronary angiography.

METHODS

3,166 patients with NSTE-ACS hospitalized between 2006 and 2014 were screened. After ex- clusions, 1,342 patients were enrolled with multivessel CAD and were divided depending on their man- agement after coronary angiography; the medical-only therapy group (n = 91), the percutaneous coronary intervention (PCI) group (n = 1,122), the coronary artery bypass grafting (CABG) group (n = 129). Propensity scores matching was used to adjust for differences in patient baseline characteristics.

RESULTS

After propensity score analysis, 273 well-matched patients were chosen. Both before and after matching, patients treated with a medical-only therapy were burdened with the highest percentage of 24-month all-cause death and non-fatal MI in comparison to PCI and CABG groups, respectively. In the CABG group, ACS-driven revascularization rate was lowest. In the overall population, PCI (HR 0.33; 95% CI 0.20-0.53; p < 0.0001) and CABG (HR 0.54; 95% CI 0.31-0.93; p = 0.028) were independent factors associated with favorable 24-month prognosis. However, in a matched population only PCI was an independent predictor of long-term prognosis with a 63% decrease of 24-month mortal- ity (HR 0.37; 95% CI 0.19-0.69; p = 0.0020).

CONCLUSIONS

In patients with multivessel CAD presenting with NSTE-ACS, medical-only man- agement is related with adverse long-term prognosis in contrast to revascularization, which reduces 24-month mortality, especially among patients undergoing percutaneous intervention. Performance of PCI is an independent factor for improving long-term prognosis.

Authors+Show Affiliations

3rd Chair and Department of Cardiology, Medical University of Silesia in Katowice, School of Medicine with the Division of Dentistry in Zabrze, Silesian Centre for Heart Diseases, Zabrze, Poland. piotr.desperak@op.pl.3rd Chair and Department of Cardiology, Medical University of Silesia in Katowice, School of Medicine with the Division of Dentistry in Zabrze, Silesian Centre for Heart Diseases, Zabrze, Poland.Division of Cardiology and Structural Heart Diseases, Medical University of Silesia in Katowice, Katowice, Poland.3rd Chair and Department of Cardiology, Medical University of Silesia in Katowice, School of Medicine with the Division of Dentistry in Zabrze, Silesian Centre for Heart Diseases, Zabrze, Poland.3rd Chair and Department of Cardiology, Medical University of Silesia in Katowice, School of Medicine with the Division of Dentistry in Zabrze, Silesian Centre for Heart Diseases, Zabrze, Poland.3rd Chair and Department of Cardiology, Medical University of Silesia in Katowice, School of Medicine with the Division of Dentistry in Zabrze, Silesian Centre for Heart Diseases, Zabrze, Poland.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28980282

Citation

Desperak, Piotr, et al. "Long-term Outcomes of Patients With Multivessel Coronary Artery Disease Presenting non-ST-segment Elevation Acute Coronary Syndromes." Cardiology Journal, vol. 26, no. 2, 2019, pp. 157-168.
Desperak P, Hawranek M, Gąsior P, et al. Long-term outcomes of patients with multivessel coronary artery disease presenting non-ST-segment elevation acute coronary syndromes. Cardiol J. 2019;26(2):157-168.
Desperak, P., Hawranek, M., Gąsior, P., Desperak, A., Lekston, A., & Gąsior, M. (2019). Long-term outcomes of patients with multivessel coronary artery disease presenting non-ST-segment elevation acute coronary syndromes. Cardiology Journal, 26(2), 157-168. https://doi.org/10.5603/CJ.a2017.0110
Desperak P, et al. Long-term Outcomes of Patients With Multivessel Coronary Artery Disease Presenting non-ST-segment Elevation Acute Coronary Syndromes. Cardiol J. 2019;26(2):157-168. PubMed PMID: 28980282.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-term outcomes of patients with multivessel coronary artery disease presenting non-ST-segment elevation acute coronary syndromes. AU - Desperak,Piotr, AU - Hawranek,Michał, AU - Gąsior,Paweł, AU - Desperak,Aneta, AU - Lekston,Andrzej, AU - Gąsior,Mariusz, Y1 - 2017/10/05/ PY - 2017/05/04/received PY - 2017/09/10/accepted PY - 2017/09/10/revised PY - 2017/10/6/pubmed PY - 2017/10/6/medline PY - 2017/10/6/entrez KW - coronary bypass grafts KW - long-term outcomes KW - multivessel coronary artery disease KW - non-ST-elevation myocardial infarction KW - percutaneous coronary intervention SP - 157 EP - 168 JF - Cardiology journal JO - Cardiol J VL - 26 IS - 2 N2 - BACKGROUND: There is paucity of data concerning the optimal revascularization in patients with mul- tivessel coronary artery disease (CAD) presenting non-ST-segment elevation acute coronary syndrome (NSTE-ACS). The aim was to evaluate long-term outcomes of patients with multivessel CAD presenting NSTE-ACS depending on the management after coronary angiography. METHODS: 3,166 patients with NSTE-ACS hospitalized between 2006 and 2014 were screened. After ex- clusions, 1,342 patients were enrolled with multivessel CAD and were divided depending on their man- agement after coronary angiography; the medical-only therapy group (n = 91), the percutaneous coronary intervention (PCI) group (n = 1,122), the coronary artery bypass grafting (CABG) group (n = 129). Propensity scores matching was used to adjust for differences in patient baseline characteristics. RESULTS: After propensity score analysis, 273 well-matched patients were chosen. Both before and after matching, patients treated with a medical-only therapy were burdened with the highest percentage of 24-month all-cause death and non-fatal MI in comparison to PCI and CABG groups, respectively. In the CABG group, ACS-driven revascularization rate was lowest. In the overall population, PCI (HR 0.33; 95% CI 0.20-0.53; p < 0.0001) and CABG (HR 0.54; 95% CI 0.31-0.93; p = 0.028) were independent factors associated with favorable 24-month prognosis. However, in a matched population only PCI was an independent predictor of long-term prognosis with a 63% decrease of 24-month mortal- ity (HR 0.37; 95% CI 0.19-0.69; p = 0.0020). CONCLUSIONS: In patients with multivessel CAD presenting with NSTE-ACS, medical-only man- agement is related with adverse long-term prognosis in contrast to revascularization, which reduces 24-month mortality, especially among patients undergoing percutaneous intervention. Performance of PCI is an independent factor for improving long-term prognosis. SN - 1897-5593 UR - https://www.unboundmedicine.com/medline/citation/28980282/Long_term_outcomes_of_patients_with_multivessel_coronary_artery_disease_presenting_non_ST_segment_elevation_acute_coronary_syndromes_ L2 - https://journals.viamedica.pl/cardiology_journal/article/view/51647 DB - PRIME DP - Unbound Medicine ER -
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