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.


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.


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


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