COMPARATIVE ANALYSIS OF OUTCOME AFTER MEDICAL THERAPY ALONE VERSUS INCOMPLETE REVASCULARIZATION ALONG WITH MEDICAL THERAPY IN PATIENTS WITH MULTI-VESSEL CORONARY ARTERY DISEASE

K MAHMOOD; I JAVAID; O ADEEB; KA HASHMI

doi:10.54112/bcsrj.v2023i1.404

Authors

K MAHMOOD Department of Cardiology, Ch Pervaiz Elahi Institute of Cardiology Multan, Pakistan
I JAVAID Department of Cardiology, Nishtar Medical University & Hospital Multan, Pakistan
O ADEEB Department of Cardiology, Ch Pervaiz Elahi Institute of Cardiology Multan, Pakistan
KA HASHMI Department of Cardiology, Nishtar Medical University & Hospital Multan, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v2023i1.404

Keywords:

Coronary artery disease, Percutaneous coronary intervention, Incomplete revascularization, Medical therapy

Abstract

The retrospective study was conducted in the Department of Cardiology, Chaudhry Pervez Elahi Institute of Cardiology, Multan, from 29-Jan-2022 to 28-Jul-2022 to compare the frequency of relief from angina after medical therapy alone versus incomplete revascularization along with medical therapy in local patients with multi-vessel coronary artery disease. A total of 60 patients were enrolled and randomly divided into groups I and II. Group I received standard medical therapy as per the operational definition. Group II underwent incomplete coronary artery re-vascularization – stent placement through PCI in the fluoroscopy suite. Post-IR, these patients also received standard medical therapy. All the patients were called for monthly follow-up. Patients having symptomatic relief from angina were placed in functional class II. Results showed that pain relief from angina was observed in 10 (16.67%) patients and not in 50 (83.33%). A group comparison of symptomatic relief from angina showed that relief was observed in 02 (6.70%) patients in group I and 08 (26.70%) patients in group II. This result was statistically significant, with a p-value of 0.038. Stratification was performed based on age, gender, diabetes, hypertension, smoking, and obesity. There was no association between these variables and angina relief in either group. It can be concluded that in multi-vessel coronary artery disease, incomplete revascularization and medical therapy are superior to medical therapy alone.

Downloads

Download data is not yet available.

References

Acerbo, V., Cesaro, A., Scherillo, G., Signore, G., Rotolo, F. P., De Michele, G., Scialla, F., Raucci, G., Panico, D., and Fimiani, F. (2023). Understanding the role of coronary artery revascularization in patients with left ventricular dysfunction and multi-vessel disease. Heart Failure Reviews, 1-10.

Akbari, T., and Al-Lamee, R. (2022). Percutaneous coronary intervention in multi-vessel disease. Cardiovascular Revascularization Medicine.

Beckman, J. A., Schneider, P. A., and Conte, M. S. (2021). Advances in revascularization for peripheral artery disease: revascularization in PAD. Circulation research 128, 1885-1912.

Dahal, S., and Budoff, M. J. (2021). Anatomic burden mostly outperforms ischemic burden: From COURAGE to ISCHEMIA. Catheterization and cardiovascular interventions: official journal of the Society for Cardiac Angiography & Interventions 98, E106-E107.

Doenst, T., Haverich, A., Serruys, P., Bonow, R. O., Kappetein, P., Falk, V., Velazquez, E., Diegeler, A., and Sigusch, H. (2019). PCI and CABG for treating stable coronary artery disease: JACC review topic of the week. Journal of the American College of Cardiology 73, 964-976.

Guo, L., Lv, H.-C., and Huang, R.-C. (2020). Percutaneous coronary intervention in elderly patients with coronary chronic total occlusions: current evidence and future perspectives. Clinical Interventions in Aging, 771-781.

Hsieh, M.-J., Chen, C.-C., Lee, C.-H., Wang, C.-Y., Chang, S.-H., Chen, D.-Y., Yang, C.-H., Tsai, M.-L., Yeh, J.-K., and Ho, M.-Y. (2019). Complete and incomplete revascularization in non-ST segment myocardial infarction with multi-vessel disease: long-term outcomes of first-and second-generation drug-eluting stents. Heart and Vessels 34, 251-258.

Kuronuma, K., Han, D., Miller, R. J., Rozanski, A., Gransar, H., Dey, D., Hayes, S. W., Friedman, J. D., Thomson, L., and Slomka, P. J. (2022). Long-term survival benefit from revascularization compared with medical therapy in patients with or without diabetes undergoing myocardial perfusion single photon emission computed tomography. Diabetes Care 45, 3016-3023.

Leviner, D. B., Torregrossa, G., and Puskas, J. D. (2018). Incomplete revascularization: what the surgeon needs to know. Annals of cardiothoracic surgery 7, 463.

Newby, D. E., Williams, M. C., and Dweck, M. R. (2021). Forget Ischemia:IIt's All About the Plaque. Vol. 144, pp. 1039-1041. Am Heart Assoc.

Patel, V., Unai, S., Gaudino, M., and Bakaeen, F. (2019). Current readings on outcomes after off-pump coronary artery bypass grafting. In "Seminars in thoracic and cardiovascular surgery", Vol. 31, pp. 726-733. Elsevier.

Saito, Y., and Kobayashi, Y. (2019). Percutaneous coronary intervention strategies in patients with acute myocardial infarction and multi-vessel disease: Completeness, timing, lesion assessment, and patient status. Journal of cardiology 74, 95-101.

Shah, R., Nayyar, M., Le, F. K., Labroo, A., Nasr, A., Rashid, A., Davis, D. A., Weintraub, W. S., and Boden, W. E. (2021). A meta-analysis of optimal medical therapy with or without percutaneous coronary intervention in patients with stable coronary artery disease. Coronary Artery Disease 33, 91-97.

Su, C.-S., Shen, C.-H., Chang, K.-H., Lai, C.-H., Liu, T.-J., Chen, K.-J., Lin, T.-H., Chen, Y.-W., and Lee, W.-L. (2019). Clinical outcomes of patients with multi-vessel coronary artery disease treated with robot-assisted coronary artery bypass graft surgery versus one-stage percutaneous coronary intervention using drug-eluting stents. Medicine 98.

Verevkin, A., von Aspern, K., Leontyev, S., Lehmann, S., Borger, M. A., and Davierwala, P. M. (2019). Early and long‐term outcomes in patients undergoing cardiac surgery following iatrogenic injuries during percutaneous coronary intervention. Journal of the American Heart Association 8, e010940.