Clinical Outcomes in Patients Undergoing Elective PCI of Cabg for Multivessel and Left Main Disease
Journal Title: International Journal of Contemporary Medical Research - Year 2017, Vol 4, Issue 2
Abstract
Introduction: Optimal revascularization strategy in patients with coronary artery disease remains a subject of debate between interventional cardiologists and surgeons. Numerous large scale randomized trials addressed this issue comparing coronary artery bypass grafting (CABG) with percutaneous coronary intervention (PCI) in patients with multivessel disease (MVD).The SYNTAX score has also established itself as an important prognostic tool in risk stratifying patients being considered for revascularization. The purpose of this study is to validate the appropriateness of SYNTAX score in management of multivessel disease in tertiary care center. Material and methods: The study population included 30 patients subjected to coronary angiography that included male and female patients aged 45yrs-73yrs admitted in cardiology department.To qualify for participation in this study coronary angiography of multi-vessel disease and left main disease was compared based upon treatment plan of either PCI or CABG for 1 year. Out of the 30 patients 14 underwent CABG and 16 were subjected to PCI.Based on coronary angiography of patients SYNTAX score was calculated and analyzed retrospectively based on outcomes of immediate, early (<3m), late outcomes over a period of one year in both PCI and CABG groups. Results: Out of 30 patients 24 were males and 6 were females. Of the 30 patients 16 patients underwent PCI with different drug eluting stents as mentioned in the chart and 14 patients underwent CABG. The descriptive statistics included variables like age with mean of 59.967, mean E.F. of 49.07, mean of number of lesions 3.700. The SYNTAX score had a mean of 18.233, mean Creatinine of 1.0167. In group statistics the p value is significant in cases of age (p=0.024), number of lesions (p=0.011), SYNTAX score (p=0.000), with non-significant values in variables like EF (P=0.865) and Creatinine (p=0.739).MACE occurred in 5 patients (16.66%): TVR in 3 (10%) with no MI, Stroke or death over a period of 1 year. The frequency of MACE was 40% in the high score group but was significantly higher than that in the low score group (60%).All these 5 patients presented with angina class III and all were subjected to coronary CT angiography and were found to have graft occlusion. Out of these five patients who developed angina after CABG 3 patients were managed medically one patient had to undergo redo surgery and one had to undergo graft stenting. Conclusion: In the current observational, relatively small study, the SYNTAX score could be a useful tool to predict 1-year clinical outcomes in patients undergoing elective PCI of CABG for multivessel and left main disease.
Authors and Affiliations
A Naga Srinivas, Prakash Chand Rana, G Ranjith Kumar
Keywords
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