Abstract
Background: The specific question of whether PCI or surgical treatment offers any advantage over medical treatment in patients with stable angina and multivessel disease remains unanswered.
Objective: To compare the major adverse cardiac event at the end of 1 year within different therapeutic modalities.
Materials & Method: Total 98 patients with angiographically documented severe CAD (SYNTAX SCORE >22) by visual assessment and documented ischemia. Patients were then randomized to continue with aggressive medical therapy alone or to undergo PCI or CABG concurrently with medical treatment. Clinical details of the studied cases was noted. Adverse and other clinical events were tracked from patients who were assessed with follow up visits every 3 months until one year.
Results: Out of total 98 patients 52.04 % patients suffered from major adverse cardiovascular events. Most common adverse event was non-fatal myocardial infarction (31.63%). proportion of patients with MACE was more among medical group followed by PTCA group and Least in CABG group (p<0.01). Deaths (5.10%) were more commonly observed in medical treatment.
Conclusion: Our study shows that there was a significant need for additional revascularization procedures in patients who underwent PCI and MT.
Keywords: Coronary artery disease, Percutaneous Coronary intervention (PCI), Coronary artery bypass graft, (CABG), major adverse cardiac event.
References
- The Norwegian Multicenter Study Group. Timolol-induced reduction in mortality and reinfarction in patients surviving acute myocardial infarction. N Engl J Med 1981; 304:801 7.
- The Scandinavian Simvastatin Survival Study (4S). Randomized trial of cholesterol lowering in 4,444 patients with coronary heart disease. Lancet 1994;344:1383–9.
- Emond M, Mock MB, Davis KB. Long-term survival of medically treated patients in the Coronary Artery Surgery Study (CASS) Registry. Circulation 1994;90:2645–57.
- Holmes DR Jr., Schwartz RS, Webster MW. Coronary restenosis: what have we learned from angiography? J Am CollCardiol 1991;17Suppl B:14B–22B.
- Nobuyoshi M, Kimura T, Nosaka H. Restenosis after successful percutaneous transluminal coronary angioplasty: serial angiographic follow-up of 229 patients. J Am CollCardiol 1988;12:616–23.
- Pepine CJ, Geller NL, Knatterud GL, et al. The Asymptomatic Cardiac Ischemia Pilot (ACIP) study: design of a randomized clinical trial, baseline data and implications for a long-term outcome trial. J Am CollCardiol 1994;24:1–10.
- Serruys PW, Unger F, Sousa JE, et al. Comparison of coronary-artery bypass surgery and stenting for the treatment of multi-vessel disease. N Engl J Med 2001;344:1117–24.
- Rodriguez A, Boullon F, Perez-Balino N, et al., the ERACI Group. Argentine randomized trial of percutaneous transluminal coronary angioplasty versus coronary artery bypass surgery in multi-vessel disease (ERACI): in-hospital results and 1-year follow-up. J Am CollCardiol 1993;22:1060–7.
- King SB III, Lembo NJ, Weintraub WS, et al. A randomized trial comparing coronary angioplasty with coronary bypass surgery: Emory Angioplasty versus Surgery Trial (EAST). N Engl J Med 1994;331: 1044–50.
- Hamm CW, Reimers J, Ischinger T, et al. A randomized study of coronary angioplasty compared with bypass surgery in patients with symptomatic multi-vessel coronary disease: German Angioplasty Bypass Surgery Investigation (GABI). N Engl J Med 1994;331:1037–43.
- The CABRI Trial Participants. First-year results of CABRI (Coronary Angioplasty versus Bypass Revascularization Investigation) Lancet 1995;346:1179–84
- The RITA-2 Trial Participants. Coronary angioplasty versus medical therapy for angina: the second Randomized Intervention Treatment of Angina (RITA-2) trial. Lancet 1997;350:461–8.
- The Bypass Angioplasty Revascularization Investigators (BARI). Comparison of coronary bypass surgery with angioplasty in patients with multi-vessel disease. N Engl J Med 1996;335:217–25.
Corresponding Author
Dr N. Pai
KMC & H, Manglore, Karnataka, India
Address- 63- B, Vasantrao Jadhav Park, Ramanand Nagar, Kolhapur, Maharashtra, India Pin- 416007
Tel: 07022129345, Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
DOI: https://dx.doi.org/10.18535/jmscr/v7i1.109
