Coronary artery disease multivessel not amenable to revascularization: contemporary cohort
DOI:
https://doi.org/10.5281/zenodo.11397136Keywords:
Cardiovascular Disease, Myocardial Revascularization, Coronary Disease, AnginaAbstract
Background: Severe diffuse coronary artery disease with anatomy that is not amenable to revascularization represents a poorly studied entity, with a poorly defined prognosis and prevalence, associated with high morbidity and mortality, poor quality of life and high hospitalization rates.
Objective: Due to the limited evidence in this clinical field and the absence of contemporary studies, we decided to explore this line of research, determining epidemiological, clinical and prognostic aspects.
Material and methods: Analytical, retrospective observational cohort study, carried out in a National Medical Center.
Results: The prevalence of three-vessel coronary artery disease not susceptible to revascularization was 12.2%, the majority were men (66%), over 65 years of age, with a high burden of comorbidities: pharmacological management consisted of beta blockers (91.5 %), antiplatelet aggregation (95.3%) and statins (95.3%): cardiovascular mortality was 9.4%, with myocardial infarction occurring in 10.4%: the predictor variables of mortality were chronic kidney disease, age over 70 years, insufficiency mitral valve.
Conclusion: Coronary artery disease of three vessels not susceptible to revascularization continues to be a frequent entity, with a high-risk clinical and anatomical profile, with a better contemporary prognosis despite the multiple gaps in knowledge that limit its understanding and treatment.
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Lenzen M, Scholte W, Norekvål TM, et al. Pharmacological treatment and perceived health status during 1-year follow up in patients diagnosed with coronary artery disease, but ineligible for revascularization. Results from the Euro Heart Survey on Coronary Revascularization. Eur J Cardiovasc Nurs. 2006; 5(2):115–21.DOI: 10.1016/j.ejcnurse.2006.01.003.
Kandzari DE, Lam LC, Eisenstein EL, et al. Advanced coronary artery disease: Appropriate end points for trials of novel therapies. Am Heart J. 2001;142(5):843–51. DOI: 10.1067/ mhj.2001.119136.
Nashef SAM, Roques F, Sharples LD, et al. Euroscore II. Eur J Cardio-thoracic Surg. 2012;41(4):734–45. DOI: 10.1093/ ejcts/ezs043.
Psaltis PJ, Simari RD. Cell therapy for refractory angina: Time for more ACTion. Stem Cell Res Ther. 2011;2(6):2010–2. DOI: 10.1186/scrt84.
Mannheimer C, Camici P, Chester MR, et al. The problem of chronic refractory angina: Report from the ESC Joint Study Group on the treatment of refractory angina. Eur Heart J. 2002; 23(5):355–70. DOI: 10.1053/euhj.2001.2706.
Perl L, Kornowski R. “No option” patients for coronary revascularization: The only thing that is constant is change. J Thorac Dis. 2019;11(Suppl 3): S300–2. DOI: 10.21037/jtd.2019.01.12.
Nussinovitch U, Shtenberg G, Roguin A, et al. A Novel Intraaortic Device Designed for Coronary Blood Flow Amplification in Unrevascularizable Patients. J Cardiovasc Transl Res 2016. 9(4):315–20. DOI: 10.1007/s12265-016-9702-4.
Kornowski R. Refractory myocardial angina and determinants of prognosis. Catheter Cardiovasc Interv. 2010;75(6):892–4. DOI: 10.1002/ccd.22583.
Jax TW, Peters AJ, Khattab AA, et al. Percutaneous coronary revascularization in patients with formerly “‘refractory angina pectoris in end-stage coronary artery disease’” - Not “‘end-stage’” after all. BMC Cardiovasc Disord. 2009;9:42. DOI: 10.1186/1471-2261-9-42.
Lozano I, Capin E, de la Hera JM, et al. Diffuse Coronary Artery Disease Not Amenable to Revascularization: Long-term Prognosis. Rev Esp Cardiol (Ed. Eng.) 2015;68(7):631–3. DOI: 10.1016/j.rec.2015.02.013.
Butman S. No Option? Maybe just a matter of time, as in No Option for now? Catheter Cardiovasc Interv. 2019;93(3):E187–8. DOI: 10.1002/ccd.28005.
Williams B, Menon M, Satran D, et al. Patients with coronary artery disease not amenable to traditional revascularization: Prevalence and 3-year mortality. Catheter Cardiovasc Interv. 2010;75(6):886–91.DOI: 10.1002/ccd.22431.
Henry TD, Satran D, Hodges JS, et al. Long-term survival in patients with refractory angina. Eur Heart J. 2013;34(34):2683–8. DOI: 10.1093/eurheartj/eht165.
Patel MR, Calhoon JH, Dehmer GJ, et al. ACC/AATS/AHA/ ASE/ASNC/SCAI/SCCT/STS 2017 Appropriate Use Criteria for Coronary Revascularization in Patients With Stable Ischemic Heart Disease: A Report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2017;69(17):2212–41. DOI: 10.1016/j.jacc.2017.02.001.
Jolicoeur EM, Cartier R, Henry TD, et al. Patients With Coronary Artery Disease Unsuitable for Revascularization: Definition, General Principles, and a Classification. Can J Cardiol. 2012;28(2 SUPPL.):S50–9. DOI: 10.1016/j.cjca.2011.10.015.
Echeverri D, Umaña JP. Medicina cardiovascular moderna: un llamado al trabajo en equipo. Rev Colomb Cardiol 2020;27(6): 497-500. DOI: 10.1016/j.rccar.2020.11.001.
Morales Salinas A. Tratamiento médico óptimo: ¿es la peor opción en la enfermedad coronaria multivaso? Rev Española Cardiol 2014;67(12):1074. DOI; 10.1016/j.recesp.2014.07.002.
Rivas SG, Flórez JMV, Gómez JLZ. Therapeutic protocol for chronic coronary syndrome. Med 2021;13(37):2157–60. DOI: 10.1016/j.med.2021.06.024.
Sharma R, Tradewell M, Kohl LP, et al. Revascularization in “no option” patients with refractory angina: Frequency, etiology and outcomes. Catheter Cardiovasc Interv. 2018;92(7):1215-9. DOI: 10.1002/ccd.27707.
Waldo SW, Secemsky EA, O’Brien C, et al. Surgical Ineligibility and Mortality Among Patients With Unprotected Left Main or Multivessel Coronary Artery Disease Undergoing Percutaneous Coronary Intervention. Circulation 2014.130(25):2295–301. DOI: 10.1161/CIRCULATIONAHA.114.011541.
Ly HQ, Nosair M, Cartier R. Surgical Turndown: “What’s in a Name?” for Patients Deemed Ineligible for Surgical Revascularization. Can J Cardiol. 2019;35(8):959–66. DOI: 10.1016/j. cjca.2019.05.017.
Truesdell AG. The Art of the Possible. Cardiovasc Revascularization Med 2020;21(3):348–9. DOI: 10.1016/j.carrev.2019. 12.037.
Kiernan TJ, Boilson BA, Sandhu GS, et al. Nonrevascularizable coronary artery disease following coronary artery bypass graft surgery: a population-based study in Olmsted County, Minnesota. Coron Artery Dis. 2009;20(2):106–11. DOI: 10.1097/ MCA.0b013e3283239819.
Achim A, Marc M, Ruzsa Z. Surgical Turned-Downed CHIP Cases—Can PCI Save the Day? Front Cardiovasc Med. 2022; 9: 1–6. DOI: 10.3389/fcvm.2022.872398.
Konstanty-Kalandyk J, Piątek J, Kędziora A, et al. Ten-year follow-up after combined coronary artery bypass grafting and transmyocardial laser revascularization in patients with disseminated coronary atherosclerosis. Lasers Med Sci. 2018;33 (7):1527–35. DOI: 10.1007/s10103-018-2514-9.
Povsic TJ, Henry TD, Ohman EM. Therapeutic Approaches for the No-Option Refractory Angina Patient. Circ Cardiovasc Interv. 2021;14(2):E009002. DOI: 10.1161/ CIRCINTERVENTIONS.120.009002.
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