Partial revascularization plus medical treatment versus medical treatment alone in patients with multivessel coronary artery disease not eligible for CABG

Abstract

Aim: The purpose of this study was to compare the impact of incomplete revascularization (IR) plus optimal medical therapy (OMT) to OMT alone on 1 year clinical outcomes in patients with multivessel coronary artery disease (MVD) who were not eligible for coronary bypass graft surgery (CABG). Methods: This is a prospective randomized study conducted on 50 selected patients with chronic stable angina with documented MVD and CABG was refused by the surgeon due to poor distal vessel quality. Patients were randomized 1:1 into two groups, group (I): 25 patients were subjected to OMT alone and group (II): 25 patients were subjected to IR plus OMT. All patients were subjected to 1 year follow up. Results: The baseline patients’ details were matched. At 1 year; death occurred slightly more in group II (16% versus 12%; p = 1.000), ACS occurred more in the group I (32% versus 16%; p = 0.321) while freedom from angina occurred more in group II (20% versus 4%; p = 0.189). The OMT alone did not affect neither the level of angina class nor EF; while the IR plus OMT markedly improved the decline in the level of angina class (p = 0.011), but it did not improve EF significantly (p = 0.326). Conclusion: In patients with MVD who were not eligible for CABG; IR plus OMT was not superior to OMT alone in improving the 1year clinical outcomes except the improvement in the level of angina class, which could be the adopted strategy to improve the quality of life in such patients but with close follow up.

Keywords

• Multivessel coronary artery disease
• Coronary artery bypass graft
• Optimal medical therapy
• Incomplete revascularization