Piotr Desperak1, Michał Hawranek2, Paweł Gąsior3, Aneta Desperak2, Andrzej Lekston2, Mariusz Gąsior2. 1. 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, Zabrze, Poland. piotr.desperak@op.pl. 2. 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, Zabrze, Poland. 3. Division of Cardiology and Structural Heart Diseases, Medical University of Silesia in Katowice, Katowice, Poland.
Abstract
BACKGROUND: There is paucity of data concerning the optimal revascularization in patients with mul- tivessel coronary artery disease (CAD) presenting non-ST-segment elevation acute coronary syndrome (NSTE-ACS). The aim was to evaluate long-term outcomes of patients with multivessel CAD presenting NSTE-ACS depending on the management after coronary angiography. METHODS: 3,166 patients with NSTE-ACS hospitalized between 2006 and 2014 were screened. After ex- clusions, 1,342 patients were enrolled with multivessel CAD and were divided depending on their man- agement after coronary angiography; the medical-only therapy group (n = 91), the percutaneous coronary intervention (PCI) group (n = 1,122), the coronary artery bypass grafting (CABG) group (n = 129). Propensity scores matching was used to adjust for differences in patient baseline characteristics. RESULTS: After propensity score analysis, 273 well-matched patients were chosen. Both before and after matching, patients treated with a medical-only therapy were burdened with the highest percentage of 24-month all-cause death and non-fatal MI in comparison to PCI and CABG groups, respectively. In the CABG group, ACS-driven revascularization rate was lowest. In the overall population, PCI (HR 0.33; 95% CI 0.20-0.53; p < 0.0001) and CABG (HR 0.54; 95% CI 0.31-0.93; p = 0.028) were independent factors associated with favorable 24-month prognosis. However, in a matched population only PCI was an independent predictor of long-term prognosis with a 63% decrease of 24-month mortal- ity (HR 0.37; 95% CI 0.19-0.69; p = 0.0020). CONCLUSIONS: In patients with multivessel CAD presenting with NSTE-ACS, medical-only man- agement is related with adverse long-term prognosis in contrast to revascularization, which reduces 24-month mortality, especially among patients undergoing percutaneous intervention. Performance of PCI is an independent factor for improving long-term prognosis.
BACKGROUND: There is paucity of data concerning the optimal revascularization in patients with mul- tivessel coronary artery disease (CAD) presenting non-ST-segment elevation acute coronary syndrome (NSTE-ACS). The aim was to evaluate long-term outcomes of patients with multivessel CAD presenting NSTE-ACS depending on the management after coronary angiography. METHODS: 3,166 patients with NSTE-ACS hospitalized between 2006 and 2014 were screened. After ex- clusions, 1,342 patients were enrolled with multivessel CAD and were divided depending on their man- agement after coronary angiography; the medical-only therapy group (n = 91), the percutaneous coronary intervention (PCI) group (n = 1,122), the coronary artery bypass grafting (CABG) group (n = 129). Propensity scores matching was used to adjust for differences in patient baseline characteristics. RESULTS: After propensity score analysis, 273 well-matched patients were chosen. Both before and after matching, patients treated with a medical-only therapy were burdened with the highest percentage of 24-month all-cause death and non-fatal MI in comparison to PCI and CABG groups, respectively. In the CABG group, ACS-driven revascularization rate was lowest. In the overall population, PCI (HR 0.33; 95% CI 0.20-0.53; p < 0.0001) and CABG (HR 0.54; 95% CI 0.31-0.93; p = 0.028) were independent factors associated with favorable 24-month prognosis. However, in a matched population only PCI was an independent predictor of long-term prognosis with a 63% decrease of 24-month mortal- ity (HR 0.37; 95% CI 0.19-0.69; p = 0.0020). CONCLUSIONS: In patients with multivessel CAD presenting with NSTE-ACS, medical-only man- agement is related with adverse long-term prognosis in contrast to revascularization, which reduces 24-month mortality, especially among patients undergoing percutaneous intervention. Performance of PCI is an independent factor for improving long-term prognosis.
Authors: Demosthenes G Katritsis; George C M Siontis; Adnan Kastrati; Arnoud W J van't Hof; Franz-Josef Neumann; Konstantinos C M Siontis; John P A Ioannidis Journal: Eur Heart J Date: 2010-08-13 Impact factor: 29.983
Authors: Gilles Montalescot; Leonardo Bolognese; Dariusz Dudek; Patrick Goldstein; Christian Hamm; Jean-Francois Tanguay; Jurrien M ten Berg; Debra L Miller; Timothy M Costigan; Jochen Goedicke; Johanne Silvain; Paolo Angioli; Jacek Legutko; Margit Niethammer; Zuzana Motovska; Joseph A Jakubowski; Guillaume Cayla; Luigi Oltrona Visconti; Eric Vicaut; Petr Widimsky Journal: N Engl J Med Date: 2013-09-01 Impact factor: 91.245
Authors: Friedrich W Mohr; Marie-Claude Morice; A Pieter Kappetein; Ted E Feldman; Elisabeth Ståhle; Antonio Colombo; Michael J Mack; David R Holmes; Marie-angèle Morel; Nic Van Dyck; Vicki M Houle; Keith D Dawkins; Patrick W Serruys Journal: Lancet Date: 2013-02-23 Impact factor: 79.321
Authors: Benjamin Williams; Madhav Menon; Daniel Satran; Daniel Hayward; James S Hodges; M Nicholas Burke; Randall K Johnson; Anil K Poulose; Jay H Traverse; Timothy D Henry Journal: Catheter Cardiovasc Interv Date: 2010-05-01 Impact factor: 2.692
Authors: Keith A A Fox; Tim C Clayton; Peter Damman; Stuart J Pocock; Robbert J de Winter; Jan G P Tijssen; Bo Lagerqvist; Lars Wallentin Journal: J Am Coll Cardiol Date: 2010-03-30 Impact factor: 24.094
Authors: Sharif A Halim; Robert M Clare; L Kristin Newby; Yuliya Lokhnygina; Marc J Schweiger; Arnoud W Hof; Judith S Hochman; Stefan K James; Harvey D White; Petr Widimsky; Amadeo Betriu; Christoph Bode; Robert P Giugliano; Robert A Harrington; Uwe Zeymer Journal: Int J Cardiol Date: 2015-11-10 Impact factor: 4.164
Authors: Marco Roffi; Carlo Patrono; Jean-Philippe Collet; Christian Mueller; Marco Valgimigli; Felicita Andreotti; Jeroen J Bax; Michael A Borger; Carlos Brotons; Derek P Chew; Baris Gencer; Gerd Hasenfuss; Keld Kjeldsen; Patrizio Lancellotti; Ulf Landmesser; Julinda Mehilli; Debabrata Mukherjee; Robert F Storey; Stephan Windecker Journal: Eur Heart J Date: 2015-08-29 Impact factor: 29.983
Authors: Wojciech Wańha; Maksymilian Mielczarek; Natasza Gilis-Malinowska; Tomasz Roleder; Marek Milewski; Szymon Ładziński; Dariusz Ciećwierz; Paweł Gąsior; Tomasz Pawłowski; Rafał Januszek; Adam Kowalówka; Michalina Kolodziejczak; Stanisław Bartuś; Marcin Gruchała; Grzegorz Smolka; Eliano Pio Navarese; Dariusz Dudek; Andrzej Ochała; Elvin Kedhi; Miłosz Jaguszewski; Wojciech Wojakowski Journal: J Clin Med Date: 2020-04-22 Impact factor: 4.241