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

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