Long-term outcomes of coronary artery bypass grafting versus percutaneous coronary intervention for Takayasu arteritis patients with coronary artery involvement

Wang, Xiao; Dang, Anhong; Lv, Naqiang; Cheng, Nan; Cheng, Xuesen; Yang, Yuejin; Song, Yunhu

doi:10.1016/j.semarthrit.2017.03.009

Cited by 42 publications

(43 citation statements)

References 23 publications

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“…The SYNTAX score was an important prognostic factor in CAD patients [28]; nevertheless, no consistent result was found in this study. In our analysis, the extent and complexity of coronary lesions including multi-vessel disease, ostial lesions, LM involvement, and SYNTAX score did not correlate with MACEs, a finding that is consistent with a recent study of patients with TA and coronary involvement [11]. Whereas active disease instead of coronary complexity was independently associated with MACEs, indicating that cardiovascular prognosis in patients with TA related coronary stenosis is largely related to the inflammatory status rather than the coronary anatomical severity.…”

Section: Discussionsupporting

confidence: 90%

“…In the present study, PCI was associated with a 4.4-fold increased risk of MACEs in comparison with CABG and medical therapy, which was driven by an increased risk of re-revascularization. These findings were consistent with recent small sample studies comparing CABG with PCI in TA [11,12]. Prior study of patients with TA and peripheral vascular complications has showed that endovascular revascularization procedures were associated with high failure rates and frequent restenosis [35].…”

Section: Discussionsupporting

confidence: 89%

“…Currently, the management strategies for coronary stenosis in TA include medical therapy and coronary revascularization [11][12][13][14][15]. The efficacy of anti-atherosclerotic medication as well as coronary revascularization including percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) has been well established in patients with atherosclerotic coronary artery disease (CAD) [16,17].…”

Section: Introductionmentioning

confidence: 99%

“…Recently with advances in revascularization, CABG and PCI have also emerged as important treatment modalities for coronary stenosis secondary to TA [19]. However, outcomes are still unsatisfactory in TA patients undergoing revascularization, with restenosis being the major problem [11,12,20,21].…”

Section: Introductionmentioning

confidence: 99%

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Comparing the effects of different management strategies on long-term outcomes for significant coronary stenosis in patients with Takayasu arteritis

Wang¹,

Zhang²,

Shen³

et al. 2020

International Journal of Cardiology

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Background: The long-term outcomes and optimal treatment strategy for patients with Takayasu arteritis (TA) and significant coronary stenosis remain unclear. We aim to investigate the prognosis of these patients according to the initial management strategy. Methods: A total of 57 consecutive patients with TA and significant coronary stenosis were included between 2002 and 2018. The cohort was divided into the percutaneous coronary intervention (PCI) group (n = 18), coronary artery bypass graft (CABG) group (n = 10), and medical-therapy group (n = 29). The primary outcome was major adverse cardiac events (MACEs) defined as a composite of cardiac death, myocardial infarction, and coronary revascularization. Results: Over a median follow-up of 4.5 (IQR 3.5-8.0) years, 24 (42.1%) patients experienced at least one MACE. The long-term rates of MACEs and re-revascularization were significantly higher in the PCI group than in the other 2 groups (HR 5.306, 95% CI 2.160-13.036, p b 0.001; HR 12.286, 95% CI 3.257-46.343, p b 0.001, respectively). The cumulative incidences of MACEs and subsequent revascularization were similar between the CABG and medical-therapy group. Active disease at baseline and PCI were independent predictors of MACEs (HR, 7.039, 95% CI 2.031-24.396; p = 0.002; HR, 4.400; 95% CI 1.804-10.727; p = 0.001, respectively) and revascularization (HR 4.632, 95% CI 1.010-21.235, p = 0.048; HR 9.820, 95% CI 2.641-36.514, p = 0.001, respectively). Conclusions: The initial baseline active disease is an important predictor of long-term outcome and subsequent revascularization in patients with TA and significant coronary artery stenosis. Also, PCI is independently associated with higher risk of MACEs and re-revascularization.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Comparing the effects of different management strategies on long-term outcomes for significant coronary stenosis in patients with Takayasu arteritis

Wang¹,

Zhang²,

Shen³

et al. 2020

International Journal of Cardiology

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“…However, for coronary artery involvement in TA, the literature suggests that coronary artery bypass grafting (CABG) is associated with better long‐term results than percutaneous coronary intervention (PCI). In a recently published series of 46 patients from China with TA (21 of whom underwent CABG, 25 underwent PCI) followed up for a median of more than 3 years, CABG was associated with significantly lower rates of major adverse cardiac events than PCI in those with active disease at the time of procedure, but the rates did not differ in presence of stable disease activity . Another study from China on 31 patients with TA (19 PCI, 12 CABG) reaffirmed these findings, with higher incidence of restenosis in those undergoing PCI when followed up for a median duration of more than 8 years .…”

Section: Vascular Interventionsmentioning

confidence: 87%

Recent advances in the management of Takayasu arteritis

et al. 2019

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Takayasu arteritis (TA) is a challenging large vessel vasculitis to treat. Distinguishing disease activity from vascular damage is difficult, often relying on clinician judgement aided by composite clinical disease activity indices with angiographic evidence of vessel wall thickening or vessel wall hypermetabolism demonstrable on positron emission tomography computerized tomography (PET CT). Glucocorticoids form the mainstay of remission induction. While other conventional disease modifying anti-rheumatic drugs (cDMARDs) or biologic DMARDs (bDMARDs) are commonly used, evidence supporting their usefulness is sparse and generally of low quality. The only two randomized controlled trials (RCT) of a DMARD in TA failed to show efficacy of abatacept in reducing relapses of TA, however, tocilizumab showed a trend towards reduction in time to relapses. Of the cDMARDs, methotrexate, azathioprine, mycophenolate mofetil (MMF), leflunomide and cyclophosphamide have shown clinical efficacy in case series, with some evidence that methotrexate, azathioprine and MMF might retard angiographic progression. Among bDMARDs, anti-tumor necrosis factor alpha agents and tocilizumab may be useful in patients refractory to cDMARDs with retardation of angiographic progression, based on evidence derived from mostly retrospective case series, whereas the role of rituximab and ustekinumab needs further elucidation. Revascularization, either surgical or endovascular, is the treatment of choice to relieve critical, symptomatic stenoses and are best undertaken during inactive disease. Emerging evidence suggests that patients with TA also have increased cardiovascular risk and this requires appropriate management. Large studies involving multiple centers are the need of the hour to appropriately evaluate utility of currently available immunosuppressive therapy in TA.

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2021 American College of Rheumatology/Vasculitis Foundation Guideline for the Management of Giant Cell Arteritis and Takayasu Arteritis

Maz

Chung

Abril

et al. 2021

Arthritis Care & Research

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Objective. To provide evidence-based recommendations and expert guidance for the management of giant cell arteritis (GCA) and Takayasu arteritis (TAK) as exemplars of large vessel vasculitis.Methods. Clinical questions regarding diagnostic testing, treatment, and management were developed in the population, intervention, comparator, and outcome (PICO) format for GCA and TAK (27 for GCA, 27 for TAK). Systematic literature reviews were conducted for each PICO question. The Grading of Recommendations Assessment, Development and Evaluation methodology was used to rate the quality of the evidence. Recommendations were developed by the Voting Panel, comprising adult and pediatric rheumatologists and patients. Each recommendation required ≥70% consensus among the Voting Panel.Results. We present 22 recommendations and 2 ungraded position statements for GCA, and 20 recommendations and 1 ungraded position statement for TAK. These recommendations and statements address clinical questions relating to the use of diagnostic testing, including imaging, treatments, and surgical interventions in GCA and TAK. Recommendations for GCA include support for the use of glucocorticoid-sparing immunosuppressive agents and the use of imaging to identify large vessel involvement. Recommendations for TAK include the use of nonglucocorticoid immunosuppressive agents with glucocorticoids as initial therapy. There were only 2 strong recommendations; the remaining recommendations were conditional due to the low quality of evidence available for most PICO questions.Conclusion. These recommendations provide guidance regarding the evaluation and management of patients with GCA and TAK, including diagnostic strategies, use of pharmacologic agents, and surgical interventions.Guidelines and recommendations developed and/or endorsed by the American College of Rheumatology (ACR) are intended to provide guidance for particular patterns of practice and not to dictate the care of a particular patient. The ACR considers adherence to the recommendations within this guideline to be voluntary, with the ultimate determination regarding their application to be made by the physician in light of each patient's individual circumstances. Guidelines and recommendations are intended to promote beneficial or desirable outcomes but cannot guarantee any specific outcome. Guidelines and recommendations developed and endorsed by the ACR are subject to periodic revision as warranted by the evolution of medical knowledge, technology, and practice. ACR recommendations are not intended to dictate payment or insurance decisions, and drug formularies or other third-party analyses that cite ACR guidelines should state this. These recommendations cannot adequately convey all uncertainties and nuances of patient care.

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Long-term outcomes of coronary artery bypass grafting versus percutaneous coronary intervention for Takayasu arteritis patients with coronary artery involvement

Cited by 42 publications

References 23 publications

Comparing the effects of different management strategies on long-term outcomes for significant coronary stenosis in patients with Takayasu arteritis

Comparing the effects of different management strategies on long-term outcomes for significant coronary stenosis in patients with Takayasu arteritis

Recent advances in the management of Takayasu arteritis

2021 American College of Rheumatology/Vasculitis Foundation Guideline for the Management of Giant Cell Arteritis and Takayasu Arteritis

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