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Comparison of multivessel percutaneous coronary intervention and coronary artery bypass grafting in patients with severe coronary artery disease presenting with non-ST-segment elevation acute coronary syndromes.
Kardiol Pol 2018; 76(10):1474-1481KP

Abstract

BACKGROUND

There are no clinical trials comparing multivessel percutaneous coronary intervention (MV PCI) with coronary artery bypass grafting (CABG) in the non-ST-segment elevation acute coronary syndrome (NSTE-ACS) population.

AIM

We sought to compare long-term outcomes of MV PCI and CABG in patients with severe coronary artery disease (CAD) presenting with NSTE-ACS.

METHODS

A total of 3166 consecutive patients with NSTE-ACS hospitalised between 2006 and 2014 were analysed. Patients with left main, proximal left anterior descending artery, or triple-vessel CAD were included in further analysis. Finally, 455 patients were enrolled and divided into two groups (MV PCI or CABG group). The Cox proportional hazards model and propensity score analysis were used to assess the effects of the treatment on 36-month outcomes.

RESULTS

MV PCI was performed in 335 patients, the remaining 120 patients underwent CABG. After propensity score analysis, 99 well-matched pairs were chosen. At 36 months MV PCI was associated with similar incidence of the composite endpoint (all-cause death, non-fatal myocardial infarction [MI], ACS-driven, revascularisation, or stroke) in both Cox proportional hazards model (hazard ratio [HR] 1.26; 95% confidence interval [CI] 0.75-2.11; p = 0.39) and propensity matched analysis (HR 1.28; 95% CI 0.75-2.21; p = 0.36). Rates of 36-month mortality were also comparable before (HR 0.90; 95% CI 0.46-1.75; p = 0.76) and after matching (HR 0.94; 95% CI 0.47-1.89; p = 0.87). Rates of MI and ACS-driven revascularisation were independently higher in MV PCI than in CABG groups (17.8% vs. 5.5%, p = 0.01, and 20.6% vs. 4.4%, p = 0.003, respectively).

CONCLUSIONS

It seems that MV PCI is comparable to CABG in terms of long-term combined endpoint and mortality in patients with severe CAD and NSTE-ACS. However, higher rates of MI and ACS-driven revascularisation were observed in the MV PCI group.

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, Skłodowskiej-Curie 9, 41-800 Zabrze, Poland. piotr.desperak@op.pl.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

30251246

Citation

Desperak, Piotr, et al. "Comparison of Multivessel Percutaneous Coronary Intervention and Coronary Artery Bypass Grafting in Patients With Severe Coronary Artery Disease Presenting With non-ST-segment Elevation Acute Coronary Syndromes." Kardiologia Polska, vol. 76, no. 10, 2018, pp. 1474-1481.
Desperak P, Hawranek M, Hrapkowicz T, et al. Comparison of multivessel percutaneous coronary intervention and coronary artery bypass grafting in patients with severe coronary artery disease presenting with non-ST-segment elevation acute coronary syndromes. Kardiol Pol. 2018;76(10):1474-1481.
Desperak, P., Hawranek, M., Hrapkowicz, T., Zembala, M. O., & Gąsior, M. (2018). Comparison of multivessel percutaneous coronary intervention and coronary artery bypass grafting in patients with severe coronary artery disease presenting with non-ST-segment elevation acute coronary syndromes. Kardiologia Polska, 76(10), pp. 1474-1481. doi:10.5603/KP.a2018.0151.
Desperak P, et al. Comparison of Multivessel Percutaneous Coronary Intervention and Coronary Artery Bypass Grafting in Patients With Severe Coronary Artery Disease Presenting With non-ST-segment Elevation Acute Coronary Syndromes. Kardiol Pol. 2018;76(10):1474-1481. PubMed PMID: 30251246.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of multivessel percutaneous coronary intervention and coronary artery bypass grafting in patients with severe coronary artery disease presenting with non-ST-segment elevation acute coronary syndromes. AU - Desperak,Piotr, AU - Hawranek,Michał, AU - Hrapkowicz,Tomasz, AU - Zembala,Michał O, AU - Gąsior,Mariusz, Y1 - 2018/09/25/ PY - 2018/04/08/received PY - 2018/07/18/accepted PY - 2018/06/22/revised PY - 2018/9/27/pubmed PY - 2019/3/22/medline PY - 2018/9/26/entrez KW - coronary artery bypass grafting KW - multivessel percutaneous coronary intervention KW - non-ST-segment elevation acute coronary syndromes SP - 1474 EP - 1481 JF - Kardiologia polska JO - Kardiol Pol VL - 76 IS - 10 N2 - BACKGROUND: There are no clinical trials comparing multivessel percutaneous coronary intervention (MV PCI) with coronary artery bypass grafting (CABG) in the non-ST-segment elevation acute coronary syndrome (NSTE-ACS) population. AIM: We sought to compare long-term outcomes of MV PCI and CABG in patients with severe coronary artery disease (CAD) presenting with NSTE-ACS. METHODS: A total of 3166 consecutive patients with NSTE-ACS hospitalised between 2006 and 2014 were analysed. Patients with left main, proximal left anterior descending artery, or triple-vessel CAD were included in further analysis. Finally, 455 patients were enrolled and divided into two groups (MV PCI or CABG group). The Cox proportional hazards model and propensity score analysis were used to assess the effects of the treatment on 36-month outcomes. RESULTS: MV PCI was performed in 335 patients, the remaining 120 patients underwent CABG. After propensity score analysis, 99 well-matched pairs were chosen. At 36 months MV PCI was associated with similar incidence of the composite endpoint (all-cause death, non-fatal myocardial infarction [MI], ACS-driven, revascularisation, or stroke) in both Cox proportional hazards model (hazard ratio [HR] 1.26; 95% confidence interval [CI] 0.75-2.11; p = 0.39) and propensity matched analysis (HR 1.28; 95% CI 0.75-2.21; p = 0.36). Rates of 36-month mortality were also comparable before (HR 0.90; 95% CI 0.46-1.75; p = 0.76) and after matching (HR 0.94; 95% CI 0.47-1.89; p = 0.87). Rates of MI and ACS-driven revascularisation were independently higher in MV PCI than in CABG groups (17.8% vs. 5.5%, p = 0.01, and 20.6% vs. 4.4%, p = 0.003, respectively). CONCLUSIONS: It seems that MV PCI is comparable to CABG in terms of long-term combined endpoint and mortality in patients with severe CAD and NSTE-ACS. However, higher rates of MI and ACS-driven revascularisation were observed in the MV PCI group. SN - 1897-4279 UR - https://www.unboundmedicine.com/medline/citation/30251246/Comparison_of_multivessel_percutaneous_coronary_intervention_and_coronary_artery_bypass_grafting_in_patients_with_severe_coronary_artery_disease_presenting_with_non_ST_segment_elevation_acute_coronary_syndromes_ L2 - https://doi.org/10.5603/KP.a2018.0151 DB - PRIME DP - Unbound Medicine ER -