Comparison of three treatment strategies for patients with triple-vessel coronary disease and left ventricular dysfunction

Abstract

Introduction: Current guidelines recommend coronary artery bypass grafting (CABG) for patients with multivessel coronary disease and left ventricular (LV) dysfunction. However, some patients undergo percutaneous coronary intervention (PCI) or solely medical therapy (MT) in actual practice. The comparison of long-term outcomes of these three treatment strategies in real world is unclear.

Methods: A total of 699 consecutive patients in a single centre from 2004 to 2011 who had TVD and LV ejection fraction ≤40%, no prior PCI or CABG and had completed a median 6.2-year follow-up were evaluated. The primary endpoint was all-cause death. The secondary endpoints included cardiac death, major adverse cardiovascular and cerebrovascular events (MACCE; composite of all-cause death, myocardial infarction, repeat revascularization, or stroke), and the individual components of the composite endpoint.

Results: One hundred forty-two patients (20.3%) underwent PCI, 201 (28.8%) underwent CABG while 356 (50.9%) received MT alone. MT alone was associated with the worst survival (P < 0.001). Compared with PCI, CABG was associated with a similar risk of all-cause death (hazard ratio [HR], 0.86; 95% confidence interval [CI], 0.52-1.41; P = 0.54) but lower risks of cardiac death (HR, 0.47; 95%CI, 0.25-0.91; P = 0.03), repeat revascularization (HR, 0.29; 95%CI, 0.10-0.85; P = 0.02), and MACCE (HR, 0.63; 95%CI, 0.43-0.93; P = 0.02).

Conclusions: For patients with TVD and LV dysfunction, both CABG and PCI were associated with a lower risk of mortality compared with MT alone. Compared with PCI, CABG has a lower risk of cardiac death, repeat revascularization, and MACCE.

Keywords: coronary artery bypass grafting; left ventricular dysfunction; medical therapy; percutaneous coronary intervention; triple-vessel disease.