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Kirov H, Fischer J, Caldonazo T, Tasoudis P, Runkel A, Soletti GJ, Cancelli G, Dell'Aquila M, Mukharyamov M, Doenst T. Coronary Artery Bypass Grafting versus Percutaneous Coronary Intervention in Patients with Chronic Total Occlusion. Thorac Cardiovasc Surg 2024. [PMID: 38759955 DOI: 10.1055/s-0044-1787014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2024]
Abstract
OBJECTIVES Mechanisms of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) differ as CABG provides surgical collateralization and may prolong life by preventing future myocardial infarctions (MIs). However, evidence for CABG in patients with chronic total occlusion (CTO) has not been fully elucidated and the impact of PCI is discussed controversially. METHODS We performed a meta-analysis of studies comparing outcomes in patients with/without multivessel disease undergoing CABG or PCI for CTO. The primary outcome was long-term all-cause mortality (≥5 years). Secondary outcomes were MIs, repeat revascularization, cardiac mortality, major adverse cardiovascular events, and stroke, as well as short-term mortality (30 days/in-hospital) and stroke. A pooled Kaplan-Meier survival curve after reconstruction analysis was generated. Random-effects models were used. RESULTS Six studies totaling 12,504 patients were included. In the pooled Kaplan-Meier analysis, PCI showed a significantly higher risk of death in the follow-up compared with CABG (hazard ratio [HR]: 2.12, 95% confidence interval [CI]: 1.88-2.38, p < 0.01). During the observation period, PCI was also associated with higher rates of MI (odds ratio [OR]: 2.86, 95% CI: 1.82-4.48, p < 0.01) and more repeat revascularization (OR: 4.88, 95% CI: 1.99-11.91, p = 0.0005). The other outcomes did not show significant differences. CONCLUSION CABG is associated with superior survival to PCI over time in patients with CTO who are eligible for both PCI and CABG. This survival advantage is associated with fewer events of MI and repeat revascularization.
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Affiliation(s)
- Hristo Kirov
- Department of Cardiothoracic Surgery, Jena University Hospital, Jena, Germany
| | - Johannes Fischer
- Department of Cardiothoracic Surgery, Jena University Hospital, Jena, Germany
| | - Tulio Caldonazo
- Department of Cardiothoracic Surgery, Jena University Hospital, Jena, Germany
| | - Panagiotis Tasoudis
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, United States
| | - Angelique Runkel
- Department of Cardiothoracic Surgery, Jena University Hospital, Jena, Germany
| | | | | | | | - Murat Mukharyamov
- Department of Cardiothoracic Surgery, Jena University Hospital, Jena, Germany
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, Jena University Hospital, Jena, Germany
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Alzahrani AH, Alabbadi S, Itagaki S, Egorova N. Temporal Trend in Revascularization for Patients With Ischemic Cardiomyopathy and Multivessel Coronary Artery Disease. J Am Heart Assoc 2024; 13:e032212. [PMID: 38240212 PMCID: PMC11056153 DOI: 10.1161/jaha.123.032212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 12/14/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Current guidelines recommend revascularization in patients with ischemic cardiomyopathy (ICM). However, there is limited information about the trends and outcomes of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in ischemic cardiomyopathy patients with multivessel coronary artery disease. METHODS AND RESULTS Using New Jersey state mandatory registries, 8083 patients with ischemic cardiomyopathy with CABG or PCI revascularization for multivessel coronary artery disease from 2007 to 2018 were included in the analysis. Joinpoint regression and multivariable logistic regression analyses were performed to assess the annual percentage change in trends and predictors of the 30-day mortality rate, respectively. A decline in CABG procedures was observed from 2007 to 2011 (annual percentage change, -11.5%; P=0.003), followed by stabilization. The PCI trend remained unchanged from 2007 to 2010 and then increased significantly (annual percentage change, 3.2%; P=0.02). In the subsample of patients with proximal left anterior descending artery plus circumflex and right coronary artery, CABG was a predominant procedure until 2011, and the proportion of both procedures did not differ thereafter. In the subsample of patients with left anterior descending artery and any other artery stenosis, PCI remained dominant from 2007 to 2018, while in patients with left main and any other artery stenosis, CABG remained dominant from 2007 to 2018 (P<0.001). The 30-day risk-adjusted mortality rate was higher after PCI versus CABG for each year, but after adjustment for completeness of revascularization, there was no difference between groups. CONCLUSIONS The patterns of revascularization procedures for patients with ischemic cardiomyopathy with multivessel coronary artery disease have changed over the years, as evidenced by the changes in CABG and PCI trends. CABG and PCI had comparable 30-day risk-adjusted mortality risks.
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Affiliation(s)
- Anas H. Alzahrani
- Department of Population Health Science and PolicyIcahn School of Medicine at Mount SinaiNew YorkNY
- Department of Surgery, Faculty of MedicineKing Abdulaziz UniversityJeddahSaudi Arabia
| | - Sundos Alabbadi
- Department of Population Health Science and PolicyIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Shinobu Itagaki
- Department of Cardiovascular SurgeryIcahn School of Medicine at Mount Sinai, The Mount Sinai HospitalNew YorkNY
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount SinaiNew YorkNY
| | - Natalia Egorova
- Department of Population Health Science and PolicyIcahn School of Medicine at Mount SinaiNew YorkNY
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Rahman A, Haider R, Shirin H, Sobhan A, Huq KE. Evaluate the Quality of Life in Patients With Percutaneous Coronary Intervention Versus Coronary Artery Bypass Graft. Cureus 2024; 16:e52645. [PMID: 38380188 PMCID: PMC10877087 DOI: 10.7759/cureus.52645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2024] [Indexed: 02/22/2024] Open
Abstract
Introduction Globally, coronary heart disease is the most imperative cause of premature death. However, timely management with percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) can improve the quality of life (QoL) and reduce mortality. The objective of this study was to evaluate the QoL between the patients who received PCI and CABG for the treatment of coronary heart disease. Materials and methods This was a retrospective observational study. Patients who underwent PCI or CABG at least three months before or more at enrollment were purposefully selected. Results A total of 156 patients were enrolled, 78 in each group. Health-related QoL was assessed by using the SF-36 scale for PCI or CABG procedures. The mean ± SD scores of QoL for PCI and CABG were 78.95 ±10.14 and 78.17 ± 10.92, respectively. Of the patients, 72.43% felt better after treatment, 17.95% felt the same as before treatment, and 9.62% felt worse than before treatment in both groups. Among CABG patients, 38.46% felt significantly better after treatment compared to PCI (33.97%) (p=0.048). Moreover, more CABG patients (6.41%) felt significantly worse than PCI patients (3.21%) after treatment (p=0.048). Male patients were significantly more in the CABG group (89.74%) compared to the PCI group (75.64%). In contrast, female patients had more PCI (24.36%) compared to CABG patients (10.26%) (p=0.020). Conclusion Subjective perceptions of physical and mental well-being improved significantly from before treatment to at least three months after treatment, and an enhanced health-related QoL was noticed for medical intervention (PCI) and surgical approach (CABG).
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Affiliation(s)
| | - Rina Haider
- Obstetrics and Gynecology, Square Hospitals Ltd, Dhaka, BGD
| | - Habiba Shirin
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Arif Sobhan
- Epidemiology and Public Health, Independent Researcher, Toronto, CAN
| | - Katm Ehsanul Huq
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
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Doenst T, Schneider U, Caldonazo T, Toshmatov S, Diab M, Siemeni T, Färber G, Kirov H. Cardiac Surgery 2022 Reviewed. Thorac Cardiovasc Surg 2023; 71:356-365. [PMID: 37196662 DOI: 10.1055/s-0043-57228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
PubMed displayed almost 37,000 hits for the search term "cardiac surgery AND 2022." As before, we used the PRISMA approach and selected relevant publications for a results-oriented summary. We focused on coronary and conventional valve surgery, their overlap with interventional alternatives, and briefly assessed surgery for aorta or terminal heart failure. In the field of coronary artery disease (CAD), key manuscripts addressed prognostic implications of invasive treatment options, classically compared modern interventions (percutaneous coronary intervention [PCI]) with surgery (coronary artery bypass grafting [CABG]), and addressed technical aspects of CABG. The general direction in 2022 confirms the superiority of CABG over PCI in patients with anatomically complex chronic CAD and supports an infarct-preventative effect as underlying mechanism. In addition, the relevance of proper surgical technique to achieve durable graft patency and the need for optimal medical treatment in CABG patients was impressively illustrated. In structural heart disease, the comparisons of interventional and surgical techniques have been characterized by prognostic and mechanistic investigations underscoring the need for durable treatment effects and reductions of valve-related complications. Early surgery for most valve pathologies appears to provide significant survival advantages, and two publications on the Ross operation prototypically illustrate an inverse association between long-term survival and valve-related complications. For surgical treatment of heart failure, the first xenotransplantation was certainly dominant, and in the aortic surgery field, innovations in arch surgery prevailed. This article summarizes publications perceived as important by us. It cannot be complete nor free of individual interpretation, but provides up-to-date information for decision-making and patient information.
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Affiliation(s)
- Torsten Doenst
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, University Hospital, Jena, Germany
| | - Ulrich Schneider
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, University Hospital, Jena, Germany
| | - Tulio Caldonazo
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, University Hospital, Jena, Germany
| | - Sultonbek Toshmatov
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, University Hospital, Jena, Germany
| | - Mahmoud Diab
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, University Hospital, Jena, Germany
| | - Thierry Siemeni
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, University Hospital, Jena, Germany
| | - Gloria Färber
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, University Hospital, Jena, Germany
| | - Hristo Kirov
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, University Hospital, Jena, Germany
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Zukowska A, Kaczmarczyk M, Listewnik M, Zukowski M. Impact of Post-Operative Infection after CABG on Long-Term Survival. J Clin Med 2023; 12:jcm12093125. [PMID: 37176568 PMCID: PMC10179034 DOI: 10.3390/jcm12093125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 04/19/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
Coronary artery bypass grafting (CABG) is one of the most common cardiac surgical procedures. It is commonly known that post-operative infection has a negative impact on the patient's short-term treatment outcomes and long-term prognosis. The aim of the present study was to assess the impact of perioperative infection on 5-year and 10-year survival in patients undergoing elective on-pump CABG surgery. The present prospective observational study was carried out between 1 July 2010 and 31 August 2012 among patients undergoing cardiac surgery at our centre. Infections were identified according to the ECDC definitions. We initially assessed the incidence of infection and its relationship with the parameters analysed. We then analysed the effect of particular parameters, including infection, on 5-year and 10-year survival after surgery. We also analysed the impact of particular types of infection on the risk of death within the period analysed. The significant risk factors for reduced survival were age (HR 1.05, CI 1.02-1.07), peripheral artery disease (HR 1.99, CI 1.28-3.10), reduced LVEF after surgery (HR 0.96, CI 0.94-0.99), post-operative myocardial infarction (HR 1.45, CI 1.05-2.02) and infection (HR 3.10, CI 2.20-4.28). We found a strong relationship between post-operative infections and 5-year and 10-year mortality in patients undergoing CABG. Pneumonia and BSI were the only types of infection that were found to have a significant impact on increased long-term mortality after CABG surgery.
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Affiliation(s)
- Agnieszka Zukowska
- Department of Infection Control, Regional Hospital Stargard, 73-110 Stargard, Poland
| | | | - Mariusz Listewnik
- Department of Cardiac Surgery, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Maciej Zukowski
- Department of Anesthesiology, Intensive Care and Acute Intoxication, Pomeranian Medical University, 70-111 Szczecin, Poland
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Ren J, Royse C, Royse A. Late Clinical Outcomes of Total Arterial Revascularization or Multiple Arterial Grafting Compared to Conventional Single Arterial with Saphenous Vein Grafting for Coronary Surgery. J Clin Med 2023; 12:2516. [PMID: 37048600 PMCID: PMC10094905 DOI: 10.3390/jcm12072516] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/17/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023] Open
Abstract
Coronary surgery provides better long-term outcomes than percutaneous coronary intervention. Conventional practice is to use a single arterial conduit supplemented by saphenous vein grafts. The use of multiple arterial revascularization (MAG), or exclusive arterial revascularization (TAR), however, is reported as having improved late survival. Survival is a surrogate for graft failure that may lead to premature death, and improved survival reflects fewer graft failures in the non-conventional strategy groups. The reasons for not using MAG or TAR may be due to perceived technical difficulties, a lack of definitive large-scale randomized evidence, a lack of confidence in arterial conduits, or resources or time constraints. Most people consider radial artery (RA) grafting to be new, with use representing approximately 2-5% worldwide, despite select centers reporting routine use in most patients for decades with improved results. In conclusion, the current body of evidence supports more extensive use of total and multiple arterial revascularization procedures in the absence of contraindications.
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Affiliation(s)
- Justin Ren
- Department of Surgery, University of Melbourne, Melbourne, VIC 3050, Australia
| | - Colin Royse
- Department of Surgery, University of Melbourne, Melbourne, VIC 3050, Australia
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, VIC 3050, Australia
- Outcomes Research Consortium, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Alistair Royse
- Department of Surgery, University of Melbourne, Melbourne, VIC 3050, Australia
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, VIC 3050, Australia
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