In multivessel coronary artery disease, a “state‐of‐the‐art” randomized clinical trial of revascularization is needed

Bang, Vigyan; Levy, Mph Michael S.

doi:10.1002/ccd.26384

Cited by 5 publications

(4 citation statements)

References 2 publications

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“…To the best of our knowledge, this is the first study that evaluated the optimal revascularization strategy for non-small non-LAD lesions during one-stop HCR surgery in the MVCAD population. MVCAD accounts for 40%-60% of patients undergoing CAG and has significantly worse prognosis compared to single-vessel disease [7]. Traditional CABG is recommended by the current guidelines as the gold standard of treatment for MVCAD patients [1,8].…”

Section: Discussionmentioning

confidence: 99%

Drug-coated balloons: A better revascularization strategy in patients with multivessel coronary artery disease undergoing one-stop hybrid coronary revascularization surgery

Fu,

Gao,

Zuo

et al. 2023

Kardiol Pol

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Background:The optimal revascularization strategy for non-left anterior descending coronary artery (LAD) lesions during one-stop hybrid coronary revascularization (HCR) surgery lacks current evidence.Aims: This study aimed to compare the outcomes of the drug-coated balloon (DCB) and drug--eluting stent (DES) strategies in patients with non-small non-LAD lesions undergoing one-stop HCR.Methods: A total of 141 consecutive patients with multivessel coronary artery disease (MVCAD) undergoing one-stop HCR between June 1, 2018 and March 1, 2022 were retrospectively included in this study. In-hospital outcomes and mid-term major adverse cardiovascular and cerebrovascular events (MACCE) were observed. Kaplan-Meier curve analysis was used to evaluate the MACCE-free survival rate. The Cox proportional hazard model was used to identify risk factors of mid-term MACCE.Results: Thirty-eight and 103 patients received only DCB or DES therapy, respectively, in this study. There were no significant differences in demographic characteristics and laboratory parameters between the two groups. The in-hospital MACCE rate in the DES group was numerically higher than that in the DCB group (9.7% vs. 5.3%, respectively), but the difference was not statistically significant (P = 0.4). The incidence of MACCE after patients' discharge was significantly higher in the DES group (22% vs. 5.3%, respectively, P = 0.02) during a median follow-up of 20 months. In multivariable Cox proportional hazard analysis, DCB therapy was independently associated with reduced risk of midterm MACCE (hazard ratio, 0.21; 95% confidence interval, 0.06-0.91; P = 0.04). Conclusion:For patients with MVCAD undergoing one-stop HCR, DCB therapy may be the optimal revascularization strategy for non-small non-LAD coronary artery lesions with a significantly lower rate of mid-term MACCE.

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Section: Discussionmentioning

confidence: 99%

Drug-coated balloons: A better revascularization strategy in patients with multivessel coronary artery disease undergoing one-stop hybrid coronary revascularization surgery

Fu,

Gao,

Zuo

et al. 2023

Kardiol Pol

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“…MVCAD is documented in 40-60% of coronary angiography patients and has a poorer prognosis compared with single-vessel disease. 13 The optimal extent of myocardial revascularization in patients with MVCAD is controversial and consensus is lacking. According to guideline recommendations, conventional CABG is considered as the standard technique for the management of MVCAD.…”

Section: Discussionmentioning

confidence: 99%

Predictive value of ACEF II score in patients with multi-vessel coronary artery disease undergoing one-stop hybrid coronary revascularization

Feng

et al. 2021

Preprint

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Background: We aimed to investigate the predictive value of recently updated ACEF II score on major adverse cardiac and cerebrovascular events (MACCE) in patients with multi-vessel coronary artery disease (MVCAD) undergoing one-stop hybrid coronary revascularization (HCR).Methods: Patients with MVCAD undergoing one-stop HCR were retrospectively recruited from March 2018 to September 2020. Several prediction risk models, including ACEF II score, were calculated for each patient. Kaplan-Meier curve was used to evaluate freedom from all-cause death and MACCE survival rates. Differences of prediction performance among risk scores for predicting MACCE were compared by receiver operating characteristic (ROC) curve. Results: According to the ACEF II score, a total of 120 patients undergoing one-stop HCR were assigned to low-score group (80 cases) and high-score group (40 cases). During the median follow-up time of 18 months, the incidence of MACCE in the low-score group and high-score group were 8.8% and 37.5%, respectively (p < 0.001); and the mortality rate of the two were 2.5% and 12.5%, respectively (p < 0.05). Moreover, the cumulative freedom from mortality (97.5% vs. 86.8%, p < 0.05) and MACCE (75.2% vs. 52.8%, p < 0.001) survival rates in the high-score group were significantly lower than in the low-score group. According to the Cox proportional hazards regression, the ACEF II score was an independent prognostic indicator for MACCE with hazards ratio (HR) 2.24, p = 0.003. The ROC curve analysis indicated that the areas under the curve (AUC) of MACCE from the ACEF II score was 0.740 (p < 0.001), while the AUC of MACCE from the SYNTAX score II CABG was 0.621 (p = 0.070) and the AUC from the EuroSCORE II was 0.703 (p < 0.001). Thus, the accurate predictive value of ACEF II score was similar to the EuroSCORE II but much higher than the SYNTAX score II CABG. Conclusion: The updated ACEF II score is a more convenient and validated prediction tool for MACCE in patients with MVCAD undergoing one-stop HCR comparing to other risk models.

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“…For patients with diabetes and severe multivessel CAD, CABG is still the standard of care based on the SYNTAX extended Survival study (SYNTAXES) 25 . Recent studies have shown that preoperative assessments using the newly developed SYNTAX score II 2020 could be useful for identifying patients with multivessel CAD who might benefit from a contemporary percutaneous coronary intervention (PCI) strategy with a favorable outcome compared with the traditional CABG strategy 26 – 28 . In addition, multivessel CAD was reported to be a strong risk factor for recurrent cardiovascular events in patients with stable post-myocardial infarction despite optimal medical treatment in a Danish nationwide register-based cohort study 29 .…”

Section: Discussionmentioning

confidence: 99%

Non-mercaptalbumin is significantly associated with the coronary plaque burden and the severity of coronary artery disease

Chou

Yasukawa

Fujino

et al. 2021

Sci Rep

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Human non-mercaptalbumin (HNA), oxidized form of serum albumin, has been reported as a useful marker in oxidative stress-related diseases; however, few reports have examined the association between HNA and the severity of coronary artery disease (CAD). The present study evaluated whether the HNA fraction is correlated with coronary artery stenosis in 140 patients considered to have a high risk of CAD or who were suspected of having acute coronary syndrome. The severity of CAD was defined by the number of stenotic coronary vessels and a severity score system (the Gensini score). HNA measurements were performed using our newly established high-performance liquid chromatography methodology. The results had shown that HNA was significantly increased in patients with three-vessel disease, compared with those without CAD or with single-vessel disease (p = 0.025), and was positively correlated with the Gensini score (ρ = 0.421, p < 0.001). A multivariate analysis showed that the number of stenotic vessels was an independent and significant factor associated with HNA (ρ = 1.246, p = 0.012). A logistic regression analysis showed that HNA was a strong predictor of multivessel CAD (odds ratio, 1.12; 95% confidence interval, 1.020–1.229; p = 0.017). These findings indicate that the measurement of HNA could be clinically practical for predicting the severity of coronary artery stenosis.

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In multivessel coronary artery disease, a “state‐of‐the‐art” randomized clinical trial of revascularization is needed

Cited by 5 publications

References 2 publications

Drug-coated balloons: A better revascularization strategy in patients with multivessel coronary artery disease undergoing one-stop hybrid coronary revascularization surgery

Drug-coated balloons: A better revascularization strategy in patients with multivessel coronary artery disease undergoing one-stop hybrid coronary revascularization surgery

Predictive value of ACEF II score in patients with multi-vessel coronary artery disease undergoing one-stop hybrid coronary revascularization

Non-mercaptalbumin is significantly associated with the coronary plaque burden and the severity of coronary artery disease

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