Abstract

FERNANDEZ, Andrés et al. Coronary angioplasty with stenting vs. coronary bypass revascularization surgery in multivessel disease. Rev. Colom. Cardiol. [online]. 2009, vol.16, n.2, pp.53-63. ISSN 0120-5633.

Multivessel coronary heart disease is a common cause of revascularization procedures either surgical or by percutaneous intervention with angioplasty and stenting. Clinical outcomes of patients treated by any of these strategies have been addressed in different randomized clinical trials with diverse results favoring one or another procedure. This is a prospective cohort clinical trial aiming to analyze clinical outcomes of 400 patients with coronary heart disease involving two or more vessels comparing the outcomes between surgery and percutaneous intervention with coronary stenting. Baseline clinical characteristics were comparable between these groups. Results: in-hospital mortality rate at 1, 6 and 12 months is similar in both revascularization procedures. Nevertheless, in-hospital morbidity is significantly higher in the coronary artery bypass graft group with higher immediate post-procedural infarct-rate compared to that of the percutaneous coronary intervention (PCI) group (4,5% vs. 0%; p = 0,005), a higher infection rate (15,8% vs. 1,6%; p = 0,001) and an extended in-hospital stay in the intensive care unit (21.8% vs. 1,1%; p = 0,001). MACE in-hospital rate associated to revascularization surgery is signifficantly higher than that found in the percutaneous group (8,9% and 10,4% respectively for the surgical group and 5,7% and 15,5% for the percutaneous group; p = NS). MACE rate at 12 months was lower in the surgical group (11,9%) when compared to the percutaneous group (19,2%; p = 0,045). This difference can be explained by a furthermore need of revascularization due to failure in the target vessel in the percutaneous coronary intervention group. Target vessel (s) failure was 4% at 30 days (p = 0.059), 12% at 6 months (p = 0.001) and 18% at 12 months of follow-up (p < 0.0001) in the stenting group versus 0% at any time in the surgical group. There was no statistical difference in mortality at 12 months. Conclusions: in this cohort of patients with two or more vessel-coronary disease, surgical revascularization offers a statistically significant higher risk of in-hospital morbidity without compromising mortality up till 12 months after the procedure. Coronary stenting was found to offer a better post-procedural morbidity profile and higher risk of vessel reintervention at 6 and 12 months due to target vessel failure. Both coronary surgical revascularization and coronary stenting offer equivalent mortality rates and MACE incidence up to 1 year of follow-up.

Keywords : angioplasty; stent; aortocoronary bypass; multivessel disease; death; myocardial infarction; revascularization.

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