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

Maira I. Madiyeva 1 2 * , Marat A. Aripov 3, Alexey Yu. Goncharov 3, Jamilya A. Мansurova 2
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1 Department of Emergency cardiology, Pavlodar Regional Cardiology Center, Pavlodar, Kazakhstan
2 Department of Therapy, Semey Medical University, Semey, Kazakhstan
3 Department of Interventional Cardiology, National Research Cardiac Surgery Center, Astana, Kazakhstan
* Corresponding Author
J CLIN MED KAZ, Volume 21, Issue 2, pp. 47-54. https://doi.org/10.23950/jcmk/14496
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Author Contributions: Conceptualization, M.A.A., M.I.M.; methodology, M.A.A., M.I.M. J.A.M.; formal analysis, J.A.M.; investigation, A.Y.G.; resources, M.IM.; data curation, M.I.M., A.Y.G.; writing – original draft preparation, M.I.M.; writing – review and editing, M.A.A.; visualization, M.I.M., A.Y.G.; supervision, M.A.A., J.A.M.; project administration, M.A.A. All authors have read and agreed to the published version of the manuscript.

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.

CITATION

Madiyeva MI, Aripov MA, Goncharov AY, Мansurova JA. Long-term outcomes of myocardial revascularization in patients with multivessel coronary artery disease and comorbid pathology. J CLIN MED KAZ. 2024;21(2):47-54. https://doi.org/10.23950/jcmk/14496

REFERENCES

  • WHO, World Health Organization. Cardiovascular diseases (CVDs). World Health Organization, Fact sheets. 2021; Available at: https://www.who.int/en/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds).Accessed 13.02.2024.
  • Chew NWS, Koh JH, Ng CH, Tan DJH, Yong JN, Lin C, et al. Coronary Artery Bypass Grafting Versus Percutaneous Coronary Intervention for Multivessel Coronary Artery Disease: A One-Stage Meta-Analysis. Front Cardiovasc Med. 2022; 9:822228. https://doi.org/10.3389/fcvm.2022.822228
  • Feng S, Li M, Fei J, Dong A, Zhang W, Fu Y, et al. Ten-year outcomes after percutaneous coronary intervention versus coronary artery bypass grafting for multivessel or left main coronary artery disease: a systematic review and meta-analysis. J Cardiothorac Surg. 2023; 18(1):54. https://doi.org/10.1186/s13019-023-02101-y
  • Kirtane AJ, Doshi D, Leon MB, Lasala JM, Ohman EM, O'Neill WW, et al. Treatment of Higher-Risk Patients With an Indication for Revascularization: Evolution Within the Field of Contemporary Percutaneous Coronary Intervention. Circulation. 2016;134(5):422-31. https://doi.org/10.1161/CIRCULATIONAHA.116.022061
  • Gu D, Qu J, Zhang H, Zheng Z. Revascularization for Coronary Artery Disease: Principle and Challenges. Adv Exp Med Biol. 2020;1177:75-100. https://doi.org/10.1007/978-981-15-2517-9_3
  • Park SJ, Ahn JM, Kim YH, Park DW, Yun SC, Lee JY, et al.; BEST Trial Investigators. Trial of everolimus-eluting stents or bypass surgery for coronary disease. N Engl J Med. 2015;372(13):1204-12. https://doi.org/10.1056/NEJMoa1415447
  • Thuijs DJFM, Kappetein AP, Serruys PW, Mohr FW, Morice MC, Mack MJ, et al.; SYNTAX Extended Survival Investigators. Percutaneous coronary intervention versus coronary artery bypass grafting in patients with three-vessel or left main coronary artery disease: 10-year follow-up of the multicentre randomised controlled SYNTAX trial. Lancet. 2019;394(10206):1325-1334. https://doi.org/10.1016/S0140-6736(19)31997-X.
  • Ahn JM, Kang DY, Yun SC, Ho Hur S, Park HJ, Tresukosol D, et al.; BEST Extended Follow-Up Study Investigators. Everolimus-Eluting Stents or Bypass Surgery for Multivessel Coronary Artery Disease: Extended Follow-Up Outcomes of Multicenter Randomized Controlled BEST Trial. Circulation. 2022;146(21):1581-1590. https://doi.org/10.1161/CIRCULATIONAHA.122.062188
  • Banning AP, Serruys P, De Maria GL, Ryan N, Walsh S, Gonzalo N, et al. Five-year outcomes after state-of-the-art percutaneous coronary revascularization in patients with de novo three-vessel disease: final results of the SYNTAX II study. Eur Heart J. 2022;43(13):1307-1316. https://doi.org/10.1093/eurheartj/ehab703
  • Biancari F, Gudbjartsson T, Heikkinen J, Anttila V, Mäkikallio T, Jeppsson A, et al. Comparison of 30-day and 5-year outcomes of percutaneous coronary intervention versus coronary artery bypass grafting in patients aged≤50 years (the Coronary aRtery diseAse in younG adultS Study). Am J Cardiol. 2014;114(2):198-205. https://doi.org/10.1016/j.amjcard.2014.04.025
  • Schulman-Marcus J, Peterson K, Banerjee R, Samy S, Yager N. Coronary Revascularization in High-Risk Stable Patients With Significant Comorbidities: Challenges in Decision-Making. Curr Treat Options Cardiovasc Med. 2019;21(1):5. https://doi.org/10.1007/s11936-019-0706-7
  • Wang R, Serruys PW, Gao C, Hara H, Takahashi K, Ono M, et al. Ten-year all-cause death after percutaneous or surgical revascularization in diabetic patients with complex coronary artery disease. Eur Heart J. 2021;43(1):56-67. https://doi.org/10.1093/eurheartj/ehab441
  • Farkouh ME, Domanski M, Dangas GD, Godoy LC, Mack MJ, Siami FS, et al; FREEDOM Follow-On Study Investigators. Long-Term Survival Following Multivessel Revascularization in Patients With Diabetes: The FREEDOM Follow-On Study. J Am Coll Cardiol. 2019;73(6):629-638. https://doi.org/10.1016/j.jacc.2018.11.001
  • Li Y, Dong R, Hua K, Liu TS, Zhou SY, Zhou N, et al. Outcomes of Coronary Artery Bypass Graft Surgery Versus Percutaneous Coronary Intervention in Patients Aged 18-45 Years with Diabetes Mellitus. Chin Med J (Engl). 2017;130(24):2906-2915. https://doi.org/10.4103/0366-6999.220305
  • Marui A, Kimura T, Nishiwaki N, Mitsudo K, Komiya T, Hanyu M, et al.; CREDO-Kyoto PCI/CABG Registry Cohort-2 Investigators. Percutaneous coronary intervention versus coronary artery bypass grafting in patients with end-stage renal disease requiring dialysis (5-year outcomes of the CREDO-Kyoto PCI/CABG Registry Cohort-2). Am J Cardiol. 2014;114(4):555-61. https://doi.org/10.1016/j.amjcard.2014.05.034
  • Lima EG, Charytan DM, Hueb W, de Azevedo DFC, Garzillo CL, Favarato D, et al. Long-term outcomes of patients with stable coronary disease and chronic kidney dysfunction: 10-year follow-up of the Medicine, Angioplasty, or Surgery Study II Trial. Nephrol Dial Transplant. 2020;35(8):1369-1376. https://doi.org/10.1093/ndt/gfy379
  • Wang R, Takahashi K, Garg S, Thuijs DJFM, Kappetein AP, Mack MJ, et al. Ten-year all-cause death following percutaneous or surgical revascularization in patients with prior cerebrovascular disease: insights from the SYNTAX Extended Survival study. Clin Res Cardiol. 2021;110(10):1543-1553. https://doi.org/10.1007/s00392-020-01802-x
  • Wang R, Tomaniak M, Takahashi K, Gao C, Kawashima H, Hara H, et al. Impact of chronic obstructive pulmonary disease on 10-year mortality after percutaneous coronary intervention and bypass surgery for complex coronary artery disease: insights from the SYNTAX Extended Survival study. Clin Res Cardiol. 2021;110(7):1083-1095. https://doi.org/10.1007/s00392-021-01833-y
  • Ono M, Kawashima H, Hara H, Mancone M, Mack MJ, Holmes DR, et al.; SYNTAX Extended Survival Investigators. Impact of major infections on 10-year mortality after revascularization in patients with complex coronary artery disease. Int J Cardiol. 2021;341:9-12. https://doi.org/10.1016/j.ijcard.2021.08.013
  • Ambrosy AP, Stevens SR, Al-Khalidi HR, Rouleau JL, Bouabdallaoui N, Carson PE, et al.; STICH Trial Investigators. Burden of medical co-morbidities and benefit from surgical revascularization in patients with ischaemic cardiomyopathy. Eur J Heart Fail. 2019;21(3):373-381. https://doi.org/10.1002/ejhf.1404
  • Mamas MA, Fath-Ordoubadi F, Danzi GB, Spaepen E, Kwok CS, Buchan I, et al. Prevalence and Impact of Co-morbidity Burden as Defined by the Charlson Co-morbidity Index on 30-Day and 1- and 5-Year Outcomes After Coronary Stent Implantation (from the Nobori-2 Study). Am J Cardiol. 2015;116(3):364-71. https://doi.org/10.1016/j.amjcard.2015.04.047
  • Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373-83. https://doi.org/10.1016/0021-9681(87)90171-8
  • Charlson M, Szatrowski TP, Peterson J, Gold J. Validation of a combined comorbidity index. J Clin Epidemiol. 1994;47(11):1245-51. https://doi.org/10.1016/0895-4356(94)90129-5
  • Madiyeva MI, Aripov MA, Pya YV, Goncharov AY, Shakirova GN. Long-term results of myocardial revascularization in patients with multivessel disease. Bratisl Lek Listy. 2023;124(3):212-220. https://doi.org/10.4149/BLL_2023_034
  • Sianos G, Morel MA, Kappetein AP, Morice MC, Colombo A, Dawkins K, et al. The SYNTAX Score: an angiographic tool grading the complexity of coronary artery disease. EuroIntervention. 2005;1(2):219-27.
  • Farooq V, van Klaveren D, Steyerberg EW, Meliga E, Vergouwe Y, Chieffo A, et al. Anatomical and clinical characteristics to guide decision making between coronary artery bypass surgery and percutaneous coronary intervention for individual patients: development and validation of SYNTAX score II. Lancet. 2013;381(9867):639-650. https://doi.org/10.1016/S0140-6736(13)60108-7
  • Thakare VS, Sontakke NG, Wasnik P Sr, Kanyal D. Recent Advances in Coronary Artery Bypass Grafting Techniques and Outcomes: A Narrative Review. Cureus. 2023;15(9):e45511. https://doi.org/10.7759/cureus.45511
  • Abubakar M, Javed I, Rasool HF, Raza S, Basavaraju D, Abdullah RM, et al. Advancements in Percutaneous Coronary Intervention Techniques: A Comprehensive Literature Review of Mixed Studies and Practice Guidelines. Cureus. 2023;15(7):e41311. https://doi.org/10.7759/cureus.41311
  • Singh M, Rihal CS, Lennon RJ, Spertus JA, Nair KS, Roger VL. Influence of frailty and health status on outcomes in patients with coronary disease undergoing percutaneous revascularization. Circ Cardiovasc Qual Outcomes. 2011;4(5):496-502. https://doi.org/10.1161/CIRCOUTCOMES.111.961375
  • Jeger R, Jaguszewski M, Nallamothu BN, Lüscher TF, Urban P, Pedrazzini GB, et al.; AMIS Plus Investigators. Acute multivessel revascularization improves 1-year outcome in ST-elevation myocardial infarction: a nationwide study cohort from the AMIS Plus registry. Int J Cardiol. 2014;172(1):76-81. https://doi.org/10.1016/j.ijcard.2013.12.083
  • Zhang YJ, Iqbal J, van Klaveren D, Campos CM, Holmes DR, Kappetein AP, et al. Smoking is associated with adverse clinical outcomes in patients undergoing revascularization with PCI or CABG: the SYNTAX trial at 5-year follow-up. J Am Coll Cardiol. 2015;65(11):1107-1115. https://doi.org/10.1016/j.jacc.2015.01.014
  • Takahashi K, Thuijs DJFM, Gao C, Ono M, Holmes DR, Mack MJ, et al.; SYNTAX Extended Survival Study Investigators. Ten-year all-cause mortality according to smoking status in patients with severe coronary artery disease undergoing surgical or percutaneous revascularization. Eur J Prev Cardiol. 2022;29(2):312-320. https://doi.org/10.1093/eurjpc/zwaa089
  • Liang F, Wang Y. Coronary heart disease and atrial fibrillation: a vicious cycle. Am J Physiol Heart Circ Physiol. 2021;320(1):H1-H12. https://doi.org/10.1152/ajpheart.00702.2020
  • Rene AG, Généreux P, Ezekowitz M, Kirtane AJ, Xu K, Mehran R, et al. Impact of atrial fibrillation in patients with ST-elevation myocardial infarction treated with percutaneous coronary intervention (from the HORIZONS-AMI [Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction] trial). Am J Cardiol. 2014;113(2):236-42. https://doi.org/10.1016/j.amjcard.2013.09.016
  • Rashid M, Kwok CS, Gale CP, Doherty P, Olier I, Sperrin M, et al. Impact of co-morbid burden on mortality in patients with coronary heart disease, heart failure, and cerebrovascular accident: a systematic review and meta-analysis. Eur Heart J Qual Care Clin Outcomes. 2017;3(1):20-36. https://doi.org/10.1093/ehjqcco/qcw025
  • Wolny R, Maehara A, Liu Y, Zhang Z, Mintz GS, Redfors B, et al. The obesity paradox revisited: body mass index and -long-term outcomes after PCI from a large pooled patient-level database. EuroIntervention. 2020;15(13):1199-1208. https://doi.org/10.4244/EIJ-D-19-00467
  • Zhang K, Wang J, Yang Y, An R. Adiposity in relation to readmission and all-cause mortality following coronary artery bypass grafting: A systematic review and meta-analysis. Obes Rev. 2019;20(8):1159-1183. https://doi.org/10.1111/obr.12855
  • Li Y, Zheng H, Yan W, Cao N, Yan T, Zhu H, et al. The impact of chronic obstructive pulmonary disease on the prognosis outcomes of patients with percutaneous coronary intervention or coronary artery bypass grafting: A meta-analysis. Heart Lung. 2023;60:8-14. https://doi.org/10.1016/j.hrtlng.2023.02.017
  • Roffi M , Angiolillo DJ , Kappetein AP. Current concepts on coronary revascularization in diabetic patients. Eur Heart J. 2011;32(22):2748–2757. https://doi.org/10.1093/eurheartj/ehr305
  • Ahmed A, Varghese KS, Fusco PJ, Mathew DM, Mathew SM, Ahmed S, et al. Coronary Revascularization in Patients With Diabetes: A Meta-Analysis of Randomized Controlled Trials and Propensity-Matched Studies. Innovations (Phila). 2023;18(1):29-40. https://doi.org/10.1177/15569845221143420