Long-term follow-up of total arterial versus conventional and hybrid myocardial revascularization: A propensity score matched analysis.
Cardiovasc Revasc Med
; 20(1): 22-28, 2019 01.
Article
em En
| MEDLINE
| ID: mdl-29716810
ABSTRACT
PURPOSE:
To evaluate the impact of the revascularization technique (by means of conventional, total arterial or hybrid myocardial revascularization) in patients with multivessel coronary artery disease.METHODS:
A propensity-score analysis of patients undergoing myocardial revascularization from 1998 to 2012 was performed based on the surgical technique utilized, either total arterial (Group1, G1,n°â¯=â¯89), conventional CABG(LIMA on LAD plus veins, Group2, G2,n°â¯=â¯89), or hybrid revascularization (LIMA on LAD plus PTCA on non-LAD vessels, Group3, G3, n°â¯=â¯89). Primary end-points were overall survival and cardiac-related death while secondary composite end-point was survival freedom from major adverse cardiac and cerebrovascular events (MACCEs) defined as myocardial infarction, cardiac death, stroke and repeated target vessel revascularization.RESULTS:
Study population was mostly affected by double-vessels disease (G1â¯=â¯2.35 vs G2â¯=â¯2.3 vs G3â¯=â¯2.4, pâ¯=â¯0.14) with a preserved LV function(G1â¯=â¯48% vs G2â¯=â¯49% vs G3â¯=â¯50%, pâ¯=â¯0.12). Hospital mortality was 0% in all groups. At a mean follow-up of 6⯱â¯2â¯years overall survival was significantly better in patients receiving total arterial myocardial revascularization (G1â¯=â¯90.4⯱â¯3.5% vs G2â¯=â¯82.3⯱â¯4.2% vs G3â¯=â¯82.1⯱â¯5.9%, pâ¯=â¯0.049) as well as freedom from MACCEs (G1â¯=â¯95.2⯱â¯2.4% vs G2â¯=â¯86.5⯱â¯4% vs G3â¯=â¯68⯱â¯6.9%, pâ¯=â¯0.001) while survival free from cardiac-related death was similar(G1â¯=â¯97.7⯱â¯1.6% vs G2â¯=â¯95.1⯱â¯2.4% vs G3â¯=â¯89.5⯱â¯5.4%, pâ¯=â¯0.08). Conversely, at 10â¯years follow-up only freedom from MACCEs was significantly better in patients of Group 1(G1â¯=â¯78.9⯱â¯8.6% vs G2â¯=â¯72.4⯱â¯5.7% vs G3â¯=â¯52⯱â¯8.7%, pâ¯<â¯0.001).CONCLUSIONS:
Total arterial revascularization provides improved outcomes at mid and long term follow-up compared with conventional or hybrid revascularization. The latter technique is particularly associated with a significantly higher incidence of late myocardial infarction and repeat revascularization.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Doença da Artéria Coronariana
/
Ponte de Artéria Coronária
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Intervenção Coronária Percutânea
Tipo de estudo:
Etiology_studies
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Observational_studies
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Risk_factors_studies
Limite:
Aged
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Aged80
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Ano de publicação:
2019
Tipo de documento:
Article