Long-term outcomes of myocardial revascularization in patients with multivessel coronary artery disease and comorbid pathology

Maira I. Madiyeva 1 2 * , Marat A. Aripov 3, Alexey Yu. Goncharov 3, Jamilya A. Мansurova 2
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1 Department of Emergency cardiology, Pavlodar Regional Cardiology Center, Pavlodar, Kazakhstan
2 Department of Therapy, Semey Medical University, Semey, Kazakhstan
3 Department of Interventional Cardiology, National Research Cardiac Surgery Center, Astana, Kazakhstan
* Corresponding Author
J CLIN MED KAZ, Volume 21, Issue 2, pp. 47-54. https://doi.org/10.23950/jcmk/14496
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Author Contributions: Conceptualization, M.A.A., M.I.M.; methodology, M.A.A., M.I.M. J.A.M.; formal analysis, J.A.M.; investigation, A.Y.G.; resources, M.IM.; data curation, M.I.M., A.Y.G.; writing – original draft preparation, M.I.M.; writing – review and editing, M.A.A.; visualization, M.I.M., A.Y.G.; supervision, M.A.A., J.A.M.; project administration, M.A.A. All authors have read and agreed to the published version of the manuscript.

ABSTRACT

Objective: To assess the long-term outcomes of myocardial revascularization in patients with multivessel coronary artery disease and varying degrees of comorbidity.
Materials and methods: 406 patients with low and moderate Syntax scores (SS) (<33) underwent primary percutaneous coronary intervention (PCI) (n=200) with a drug-eluting stent, and coronary artery bypass grafting (CABG) (n=206). Patients were stratified by the Charlson Comorbidity Index (CCI) into 2 groups: 1) CCI ≤ 3(n=108/26.6%); 2) CCI ≥ 4(n=298/73.4%). 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, decreased left ventricular ejection fraction, and high SS in dynamics.
Results: An increase in CCI of more than 4 points was significantly associated with the risk of developing a combination of MACCE (HR 1.3, CI 1.2 – 1.4, p<0.001), all-cause mortality (HR 1.3, CI 1.2 – 1.4, p<0.001), and cerebrovascular accidents (CVA) (HR 2.2, CI 1.4 – 3.4, p=0.001). Patients with CCI ≥4 required repeat revascularization more frequently after PCI than after CABG (HR 2.6, CI 1.8 – 3.7, p<0.001). Among patients with varying degrees of comorbidity, the risk of progression of coronary atherosclerosis (SS≥33) was higher after CABG compared with PCI.
Conclusion: A CCI score of more than 4 points was associated with an increased risk of developing of MACCE, all-cause mortality, and CVA. Among patients with varying degrees of comorbidity, PCI and CABG did not demonstrate significant advantages in terms of MACCE.
Keywords: Coronary Artery Disease, Percutaneous Coronary Intervention, Coronary Artery Bypass Grafting, Comorbidity

CITATION

Madiyeva MI, Aripov MA, Goncharov AY, Мansurova JA. Long-term outcomes of myocardial revascularization in patients with multivessel coronary artery disease and comorbid pathology. J CLIN MED KAZ. 2024;21(2):47-54. https://doi.org/10.23950/jcmk/14496

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