Vol 72, No 3 (2014)
Original articles
Published online: 2014-03-19

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Characteristics, management and five-year outcomes of patients with high risk, stable multivessel coronary heart disease

Radosław Kręcki, Agata Arazińska, Jan Zbigniew Peruga, Michał Plewka, Jarosław Damian Kasprzak, Maria Krzemińska-Pakuła
Kardiol Pol 2014;72(3):262-268.

Abstract

Background: Multivessel coronary artery disease (MCAD) is a common manifestation of advanced coronary atherosclerosis.

Aim: To determine the clinical characteristics and long term follow up prognostic factors in patients with high risk, stable MCAD from a single institution.

Methods: We included in the final analysis 270 patients with stable MCAD. Patients were followed for the occurrence of death, stroke and myocardial infarction (MI). We defined a cumulative major adverse cardiac and cerebrovascular event (MACCE) asa composite of death, stroke, MI and urgent revascularisation. Median follow up was 5 years (4–5.5 years). 176 (65%) patients were treated surgically (coronary artery bypass grafting, CABG), 19 (7%) patients were treated percutaneously, while 75 (28%) patients were treated medically; this meant that 94 (35%) patients were treated non-surgically.

Results: Predictors of MACCE in the study group of patients revealed by univariate logistic regression analysis were: diabetesmellitus (p = 0.04), kidney failure (p = 0.05), total cholesterol (p = 0.05), LDL-cholesterol (p = 0.02), chest pain symptoms in CCS III class (p = 0.05), heart rate (p = 0,02), NT-proBNP (p = 0.01), left ventricular diastolic (p = 0.003) and systolic diameter (p = 0.003), left ventricular ejection fraction (p = 0.001), Gensini score (p = 0.05) and CABG treatment strategy (p = 0.001). In Cox logistic regression analysis, non CABG treatment strategy (b = 0.06), heart rate (b = 0.02), and LDL cholesterol level (b = 0.006) were independent predictors of MACCE (p = 0.01).

Conclusions: Our study showed that patients with advanced MCAD who are qualified for complete surgical revascularisation benefitted more with regard to several primary end points at five-year follow-up than those who were not qualified for surgery and who were treated with medical therapy supplemented in selected cases with incomplete percutaneous revascularisation.

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Polish Heart Journal (Kardiologia Polska)