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• W2893856886 abstract "Multivessel coronary artery disease (MVD) predisposes patients to increased risk of cardiovascular morbidity and mortality. Current guidelines from the Canadian Cardiovascular Society (CCS) outline evidence for Coronary Artery Bypass Grafting (CABG) in high anatomical complexity patients, but in low anatomical complexity patients, percutaneous coronary intervention (PCI) can be an acceptable alternative. The goal of this study is to retrospectively assess outcomes of PCI and CABG in patients with MVD and low disease complexity who were completely revascularized. This study captures all patients who were treated for triple-vessel disease via PCI or CABG in the province of Newfoundland & Labrador. Patients were screened for >70% stenosis in three major cardiac territories, not including the left main coronary artery. All patients undergoing CABG or PCI were reviewed at multi-disciplinary team rounds by cardiac surgery and interventional cardiology. The patients collectively identified as being “low anatomical risk” were included. In addition, patients were required to have been completely revascularized in each territory. A total of 1604 patients were extracted from the Alberta Provincial Project for Outcome Assessment in Coronary Heart disease (APPROACH) database, with 45 patients in the PCI cohort and 1559 patients in the CABG cohort (median follow up = 5.4 years; Figure 1). The primary outcome of in-hospital mortality rates were 2.2% and 1.2% in the PCI and CABG cohorts, respectively (p=0.533). Mortality rates at one year, three years, and five years post-operation were 8.6%, 14.3%, and 30% for the PCI cohort and 2.7%, 6.4%, and 12.6% for the CABG cohort. A matched comparison was completed using a propensity score model with a match tolerance of 0.05 on the following variables: Sex, Age, Type 2 Diabetes, Ejection Fraction <50%, and Renal Insufficiency. After matching 36 patients in the PCI cohort to 36 patients in the CABG cohort, the in-hospital mortality rates were 0% and 2.8%, respectively (p=0.317). Finally, 5-year mortality rates were 5.4% for the 296 patients treated with bilateral internal mammary artery grafts and 15.2% for the 564 patients treated with single internal mammary artery grafts. Early survival rates are comparable in low-risk triple-vessel disease patients revascularized with either therapy; however, at three years there appears to be an improvement with CABG therapy. A secondary outcome of this study shows that the graft strategy of using bilateral internal mammary artery compared to a single internal thoracic artery appears to have a medium-term survival benefit." @default.
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• W2893856886 date "2018-10-01" @default.
• W2893856886 modified "2023-09-25" @default.
• W2893856886 title "LOW RISK PERCUTANEOUS CORONARY INTERVENTION VERSUS CORONARY ARTERY BYPASS GRAFTING IN COMPLETELY REVASCULARIZED TRIPLE VESSEL DISEASE PATIENTS" @default.
• W2893856886 doi "https://doi.org/10.1016/j.cjca.2018.07.284" @default.
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