Khosravi Alireza, Vakhshoori Mehrbod, Sharif Vahid, Roghani-Dehkordi Farshad, Najafian Jamshid, Mansouri Asieh
Professor, Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
ARYA Atheroscler. 2020 Mar;16(2):85-93. doi: 10.22122/arya.v16i2.2019.
The probable complications of 3 different cardiovascular diseases treatment options including percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG), and medical therapy (MT), especially in individuals suffering from left main (LM) and/or three vessel diseases (3VDs), have received less attention. Thus, the aim of this study was to compare the complications of the aforementioned therapeutic strategies in patients admitted with LM coronary artery disease (CAD) and/or having 3VDs.
From March 2018 to March 2019, a total number of 251 eligible individuals (87, 86, and 78 subjects treated with PCI, CABG, and MT, respectively) were recruited in this cohort study. After the initiation of treatment, all individuals were followed for 6 months. Occurrence of any complications including chest pain (CP), re-hospitalization due to cardiac problems, heart failure (HF), death, myocardial infarction (MI), and stroke as well as major adverse cardiac events (MACE) were assessed.
Significantly lower percentages of CP, readmission, and HF were observed in the CABG group compared to the PCI and MT groups (24.4% vs. 47.1% and 53.9%, P < 0.001; 3.5% vs. 13.8% and 5.1%, P = 0.020; 1.2% vs. 2.3% and 9%; P = 0.040, respectively). Further analysis revealed an increased likelihood of hospitalization in the PCI group (OR: 3.82, 95% CI: 1.01-14.41, P = 0.040), and a lower risk of CP and HF occurrence in the CABG group subjects compared to the MT group (OR: 0.28, 95% CI: 0.13-0.62, P = 0.002 and OR: 0.05, 95% CI: 0.004-0.71, P = 0.030, respectively). This pattern was also observed in the PCI group in terms of HF (OR: 0.12, 95% CI: 0.02-0.83, P = 0.030).
Patients suffering from LM and/or 3VDs would most likely benefit from CABG followed by PCI, rather than MT. Further large-scale studies are required to confirm these results.
三种不同的心血管疾病治疗方案，包括经皮冠状动脉介入治疗（PCI）、冠状动脉旁路移植术（CABG）和药物治疗（MT），其可能出现的并发症，尤其是在患有左主干（LM）和/或三支血管病变（3VDs）的个体中，受到的关注较少。因此，本研究的目的是比较上述治疗策略在因LM冠状动脉疾病（CAD）入院和/或患有3VDs的患者中的并发症情况。
在这项队列研究中，从2018年3月至2019年3月，共招募了251名符合条件的个体（分别有87、86和78名接受PCI、CABG和MT治疗的受试者）。治疗开始后，对所有个体进行了6个月的随访。评估了包括胸痛（CP）、因心脏问题再次住院、心力衰竭（HF）、死亡、心肌梗死（MI）和中风以及主要不良心脏事件（MACE）在内的任何并发症的发生情况。
与PCI组和MT组相比，CABG组中CP、再次入院和HF的发生率显著更低（分别为24.4%对47.1%和53.9%，P<0.001；3.5%对13.8%和5.1%，P = 0.020；1.2%对2.3%和9%；P = 0.040）。进一步分析显示，PCI组住院的可能性增加（OR：3.82，95%CI：1.01 - 14.41，P = 0.040），与MT组相比，CABG组受试者发生CP和HF的风险更低（分别为OR：0.28，95%CI：0.13 - 0.62，P = 0.002和OR：0.05，95%CI：0.004 - 0.71，P = 0.030）。在HF方面，PCI组也观察到了这种模式（OR：0.12，95%CI：0.02 - 0.83，P = 0.030）。
患有LM和/或3VDs的患者最有可能从CABG继以PCI中获益，而不是MT。需要进一步的大规模研究来证实这些结果。
