Multivessel coronary artery disease: current revascularization strategies

Patil, Chandrashekhar V.

doi:10.1053/euhj.2000.2497

Cited by 10 publications

(11 citation statements)

References 111 publications

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“…Although percutaneous coronary intervention (PCI) was initially intended as a treatment for single-vessel coronary artery disease, technical progress including the development of coronary stents has allowed PCI to be considered an alternative to coronary artery bypass graft surgery (CABG) in patients with multivessel disease (MVD) [1,2]. A number of randomized studies comparing CABG and PCI in patients with MVD suggest similar outcomes with respect to death and acute myocardial infarction (AMI).…”

Section: Introductionmentioning

confidence: 99%

Percutaneous coronary intervention or bypass surgery in multivessel disease? A tailored approach based on coronary pressure measurement

Botman

Pijls

Bech

et al. 2004

Cathet Cardio Intervent

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The optimal revascularization strategy, percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG), for patients with multivessel coronary artery disease (MVD) remains controversial. The aim of the present study was to compare the long-term outcomes after selective PCI of only hemodynamically significant lesions (fractional flow reserve, or FFR < 0.75) to CABG of all stenoses in patients with MVD. In 150 patients with MVD referred for CABG, FFR was determined in 381 coronary arteries considered for bypass grafting. If the FFR was less than 0.75 in three vessels or in two vessels including the proximal left anterior descending (LAD) artery, CABG was performed (CABG group). If only one or two vessels were physiologically significant (not including the proximal LAD), PCI of those lesions was performed (PCI group). Of the 150 patients, 87 fulfilled the criteria for CABG and 63 for PCI. There were no significant differences in the angiographic or other baseline characteristics between the two groups. At 2-year follow-up, no differences were seen in adverse events, including repeat revascularization (event-free survival 74% in the CABG group and 72% in the PCI group). A similar number of patients were free from angina (84% in the CABG group and 82% in the PCI group). Importantly, the results in both groups were as good as the surgical groups in previous studies comparing PCI and CABG in MVD. In patients with multivessel disease, PCI in those with one or two hemodynamically significant lesions as identified by an FFR < 0.75 yields a similar favorable outcome as CABG in those with three or more culprit lesions despite a similar angiographic extent of disease.

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Section: Introductionmentioning

confidence: 99%

Percutaneous coronary intervention or bypass surgery in multivessel disease? A tailored approach based on coronary pressure measurement

Botman

Pijls

Bech

et al. 2004

Cathet Cardio Intervent

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“…While coronary artery stenting is increasingly being used to treat these patients, stenting is associated with a greater need for repeated procedures in comparison with coronary artery bypass graft surgery (CABG) (16). Therefore, CABG remains an important treatment for multivessel disease (16, 17). The use of arterial conduits has improved the outcome of CABG, yet autologous vein grafts provide an important and convenient conduit for bypass graft surgery (18, 19).…”

mentioning

confidence: 99%

Absence of heme oxygenase‐1 exacerbates atherosclerotic lesion formation and vascular remodeling

et al. 2003

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To examine the role of heme oxygenase (HO)-1 in the pathophysiology of vascular diseases, we generated mice deficient in both HO-1 and apolipoprotein E (HO-1-/-apoE-/-). Despite similar total plasma cholesterol levels in response to hypercholesterolemia, HO-1-/-apoE-/- mice, in comparison with HO-1+/+apoE-/- mice, had an accelerated and more advanced atherosclerotic lesion formation. In addition to greater lipid accumulation, these advanced lesions from HO-1-/-apoE-/- mice contained macrophages and smooth muscle alpha-actin-positive cells. We further tested the role of HO-1 on neointimal formation in a mouse model of vein graft stenosis. Autologous vein grafts in HO-1-/- mice showed robust neointima consisting of alpha-actin-positive vascular smooth muscle cells (VSMC) 10 days after surgery in comparison to the smaller neointima formed in autologous vein grafts in HO-1+/+ mice. However, at 14 days after surgery, the neointima from composite vessels of HO-1-/- mice was composed mainly of acellular material, indicative of substantial VSMC death. VSMC isolated from HO-1-/- mice were susceptible to oxidant stress, leading to cell death. Our data demonstrate that HO-1 plays an essential protective role in the pathophysiology of atherosclerosis and vein graft stenosis.

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“…Впервые о подходах к реваскуляризации миокарда при многососудистом поражении коронарного русла заговорили в сердечно-сосудистой хирургии, когда было обнаружено, что исход заболевания во многом зависит от того, насколько полной была реваскуляризация коронарных артерий. Результаты первых исследований показали, что пациенты, у которых была достигнута полная реваскуляризация коронарных артерий, имели лучшую выживаемость и более гладкое течение заболевания [2,11]. Тем не менее, отдельные авторы указывали на то, что с увеличением продолжительности наблюдения первоначальные преимущества полной реваскуляризации миокарда утрачиваются [2,4,11].…”

Section: Discussionunclassified

Endovascular Treatment of Ischemic Heart Disease in Patients With Multivessel Coronary Artery Disease: Immediate and Long-Term Results

et al. 2012

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Immediate and long-term results of endovascular treatment of multivessel coronary artery disease by using different revascularization strategies were analyzed in 171 patients. Duration of follow up ranged from 12 to 18 months. Complete myocardium revascularization was performed in 63 patients, culprit vessel revascularization ― in 86 pts and incomplete revascularization ― in 22 pts. Results of this study showed that strategy of complete and culprit vessel revascularization in patients with multivessel coronary artery disease has comparable immediate and long-term results. Strategy of incomplete revascularization reduce immediate clinical success and lead to increased number of myocardial infarctions and needs of coronary artery bypass surgery in long-term follow-up period.

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Multivessel coronary artery disease: current revascularization strategies

Cited by 10 publications

References 111 publications

Percutaneous coronary intervention or bypass surgery in multivessel disease? A tailored approach based on coronary pressure measurement

Percutaneous coronary intervention or bypass surgery in multivessel disease? A tailored approach based on coronary pressure measurement

Absence of heme oxygenase‐1 exacerbates atherosclerotic lesion formation and vascular remodeling

Endovascular Treatment of Ischemic Heart Disease in Patients With Multivessel Coronary Artery Disease: Immediate and Long-Term Results

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