Revascularization Strategies and Survival in Patients With Multivessel Coronary Artery Disease

Noam Fink, Eugenia Nikolsky, Abid Assali, Oz Shapira, Yigal Kassif, Yaron D. Barac, Ariel Finkelstein, Amnon Eitan, Haim Danenberg, Doron Zahger, Gideon Sahar, Shaul Atar, Ehud Raanani, Gil Bolotin, Ilan Goldenberg, Amit Segev

Research output: Contribution to journalArticlepeer-review

13 Scopus citations

Abstract

Background: We sought to assess real-world implementation of the guidelines in patients with multivessel coronary artery disease (CAD) using a prospective national registry in Israel. Methods: All consecutive patients with left main or 2- to 3-vessel CAD involving the proximal or mid left anterior descending artery were enrolled in a dedicated multicenter registry. Patients were managed at the discretion of the treating team at each hospital and were followed for 30 months. Results: This registry included 1,064 patients, 55% treated with percutaneous coronary intervention (PCI) and 45% with coronary artery bypass surgery (CABG). Multivariate logistic regression analysis showed that chronic renal failure (odds ratio [OR], 2.43; p = 0.001) and prior myocardial infarction (OR, 1.7; p = 0.024) were associated with referral to PCI versus CABG, whereas male gender (OR, 2.27; p < 0.001), prior aspirin treatment (OR, 1.72; p = 0.005), diabetes mellitus (OR, 1.51; p = 0.007), 3-vessel CAD (OR, 3.45; p < 0.001) and SYNTAX score (SS) greater than 32 (OR, 10.0; p < 0.001) were associated with referral to CABG versus PCI. Each point increment in the SS was independently associated with a 9% greater likelihood of referral to CABG (p < 0.001). Survival analysis showed that mortality risk was lower among PCI patients less than 8 months after the procedure, and CABG was associated with a significant survival benefit thereafter. Conclusions: We found good agreement with current guidelines regarding revascularization strategies in real-world patients with multivessel CAD. The SS was the main independent predictor associated with the choice of revascularization strategy. The time-dependent association between revascularization strategy and long-term survival should be incorporated in the risk assessment of this population.

Original languageEnglish
Pages (from-to)106-111
Number of pages6
JournalAnnals of Thoracic Surgery
Volume107
Issue number1
DOIs
StatePublished - Jan 2019

Bibliographical note

Publisher Copyright:
© 2019 The Society of Thoracic Surgeons

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