Comparison of Long-term Outcomes in Patients with Premature Triple-vessel Coronary Disease Undergoing Three Different Treatment Strategies

Abstract

Background:Patients with premature triple-vessel disease (PTVD) have a higher risk of recurrent coronary events and repeat revascularization; however, the long-term outcome of coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), and medical therapy (MT) alone for PTVD patients is controversial. The aim of this study is to evaluate the long-term outcome of PTVD patients among these three treatment strategies, to find out the most appropriate treatment methods for these patients.Methods:One thousand seven hundred and ninety-two patients with PTVD (age: men ≤50 years and women ≤60 years) were enrolled between 2004 and 2011. The primary end point was all-cause death. The secondary end points were cardiac death, myocardial infarction, stroke, or repeat revascularization.Results:PCI, CABG, and MT alone were performed in 933 (52.1%), 459 (25.6%), and 400 (22.3%) patients. Both PCI and CABG were associated with lower all-cause death (4.6% vs. 4.1% vs. 15.5%, respectively, P < 0.01) and cardiac death (2.8% vs. 2.0% vs. 9.8%, respectively, P < 0.01) versus MT alone. The rate of repeat revascularization in the CABG group was significantly lower than those in the PCI and MT groups. After adjusting for baseline factors, PCI and CABG were still associated with similar lower risk of all-cause death and cardiac death versus MT alone (all-cause death: hazard ratio [HR]: 0.35, 95% confidence interval [CI]: 0.23–0.53, P < 0.01 and HR: 0.35, 95% CI: 0.18–0.70, P = 0.003, respectively, and cardiac death: HR: 0.32, 95% CI: 0.19–0.54, P < 0.01 and HR: 0.36, 95% CI: 0.14–0.93, P = 0.03, respectively).Conclusions:PCI and CABG provided equal long-term benefits for all-cause death and cardiac death for PTVD patients. Patients undergoing MT alone had the worst long-term clinical outcomes.Trial Registration:ClinicalTrials.gov; Identifier: NCT02634086. https://www.clinicaltrials.gov/ct2/show/record/NCT02634086?term=NCT02634086&rank=1

Mortality probabilities after revascularization and medical therapy in CAD patients under 60 years old: a meta-analysis study

“…Clinical trial and cohort studies provide suitable information on the effectiveness of treatments. The effectiveness among patients in studies may have differences and similarities [ 14 – 22 ]. The results of a single study are not sufficient to make a decision.…”

“…The age range of this study (20–60 years old) is very close to the PCAD age range. As in most literature works, premature coronary artery disease (PCAD) is defined as the occurrence of an acute myocardial infarction (MI) or a symptomatic myocardial ischemia with an obstructive coronary artery disease (stenosis 70%) before age 55 [ 6 , 14 , 21 ].…”

“…Because it was obtained from three studies. The full population of one of the studies (Li et al) consisted of diabetic and another study (LOTOS) consisted of TVD patients [ 14 , 21 ]. But for death probability after PCI, two other factors played a more important role.…”

“…Then, the team of authors reviewed the full text of two reviewer for the final selection. Finally, nine studies were selected [ 14 – 22 ]. Table 4 lists the characteristics of the studies, included year, country, design, comparison groups, etc.…”

Procedure and Effectiveness of Extracorporeal Membrane Oxygenation in Percutaneous Coronary Intervention for High-risk Complex Coronary Disease

“…The percutaneous coronary intervention (PCI) has developed rapidly during the past four decades, which has increasingly become one of the mainstream treatments for coronary atherosclerotic heart disease (CHD) [1][2][3]. Previous studies have shown that revascularization therapy, both PCI and coronary artery bypass graft (CABG), could reduce all-cause mortality and cardiac death among patients with complex high-risk coronary disease in contrast to conventional medication treatments [4,5]. Regarding the preference for the revascularization strategy, numerous studies recommend CABG to patients who are under such complex high-risk coronary conditions [6][7][8][9].…”