Prognosis Of Multivessel Coronary Disease In Different Treatment Strategies And The Relationship With Associated Risk Factors

Objective:A retrospective comparison of long-term curative effect of different treatment options on multiple-vessel coronary artery disease and clinical relationship between risk factors and prognosis.Methods:A total of2,943patients with coronary angiography showed multiple-vessel coronary artery disease (MVD) and/or left main coronary artery disease were selected in Tianjin Chest Hospital from January2009to June2010. Basic clinical conditions, the SYNTAX score of coronary artery and the treatment strategy were analyzed retrospectively in patients. Major adverse cardiac or cerebrovascular events (MACCE) include:death, myocardial infarction again, revascularization, and stroke were follow-up by telephone enquiries or out-patient or in-patient medical consultation, at a mean follow-up of29.5months(29.5±5.35). Follow-up success rate was89.8%and patients were2,448. All patients by treatment strategy is divided into three groups:PCI group, CABG group and drug treatment group, and the prognosis were compared by different treatment strategies. The patients with left main coronary artery disease is divided into three groups by treatment strategy:PCI group, CABG group and drug treatment group, and the prognosis were compared by different treatment strategies. The PCI group were subdivided into2groups, the incomplete revascularization group and the complete revascularization group, and the prognosis were compared. Correlative analysis between SYNTAX score of all patient and clinical data determine the factors that influence the severity of coronary artery disease. Regression analysis between MACCE incidence of all patient and clinical data judge independent risk factors for MACCE.Results:1. Prognostic comparison of all groups of different treatment strategies in patients is that drug treatment group is the highest mortality and PCI group mortality rate is higher than CABG group(p<0.05). The myocardial infarction again rate of PCI group is higher obviously than CABG group’s (p<0.05), and is similar with drug treatment group’s(p>0.05). The stroke rate of CABG group is higher obviously than PCI group’s(2.81%vs.1.52%, p<0.05), and is similar with drug treatment group’s (p>0.05). The revascularization rate of PCI group is higher obviously than CABG group’s (p<0.05). The total MACCE rate of drug treatment group is the highest(p<0.05). According to statistical analysis of survival rate of the three groups, the survival rate of CABG group is the highest(p<0.05). Cox regression shows SYNTAX score is an independent risk factor for MACCE, and treatment strategies is an independent risk factor for MACCE.2. Prognostic comparison of all groups of different treatment strategies in patients with left main coronary artery disease is that drug treatment group is the highest in the total MACCE rate (p<0.05),but the rate of PCI group and CABG group was not statistically significant difference. Drug treatment group is the highest mortality and PCI group mortality rate is higher than CABG group(p<0.05). The myocardial infarction again rate of PCI group is higher obviously than CABG group’s (p<0.05), and is similar with drug treatment group’s(p>0.05). The stroke rate of CABG group is higher obviously than PCI group’s(p<0.05), and is similar with drug treatment group’s (p>0.05). The revascularization rate of PCI group is higher obviously than CABG group’s (p<0.05). The total MACCE rate of drug treatment group is the highest(p<0.05). According to statistical analysis of survival rate of the three groups, the survival rate of CABG group is the highest(p<0.05). Cox regression shows SYNTAX score is an independent risk factor for MACCE, and treatment strategies is an independent risk factor for MACCE.3. Prognostic comparison of two groups of different revascularization strategies in PCI patients is that the incomplete revascularization group is the higher obviously in the total MACCE rate (p<0.01). The incomplete revascularization group is the higher obviously than the complete revascularization group in the rates of death, myocardial infarction again, revascularization, and stroke. Cox regression shows treatment strategies is an independent risk factor for MACCE.4. SYNTAX score and age, BMI, high blood pressure, diabetes, there is a positive correlation (p<0.05), but sex, smoking history, history of alcohol intake, family history of coronary heart disease, myocardial infarction and cerebral vascular illness, kidney illness history does not have a relationship with SYNTAX score.5. Age, BMI, smoking history, family history of coronary heart disease, hypertension history, history of diabetes, history of myocardial infarction are independent risk factors for MACCE, more effects including hypertension and diabetes. FBG, TC, LDL-C, LP(a), UA, FIB, LVEF, LVEDd and SYNTAX score are independent risk factors for MACCE, and left main coronary artery disease, anterior descending artery lesion in the proximal, three-vessel, incomplete revascularization are independent risk factors of MACCE.Conclusions:1.The prognosis of different treatment strategies in patients with MVD is different. In the low risk group (SYNTAX score<23), the prognosis of three kinds of treatment are not obviously different. But in high risk groups (SYNTAX score>33), drug treatment group is the highest mortality and PCI group mortality rate is higher than CABG group(p<0.05). The effect of PCI and CABG group is similar in media SYNTAX score crisis group. The recurrent myocardial infarction and revascularization rate of PCI group is higher than the CABG group again, which have higher stroke incidence than the former.2. For left main coronary artery disease, the CTO lesions, three-vessel lesions and anterior descending artery lesion in the proximal rate of the CABG group is higher than PCI group and drug treatment group. In the total MACCE rate comparisons, the drug treatment group is the highest. The comparison of different groups of revascularization, the myocardial infarction again and revascularization rate is the higher than the CABG Group, and the latter’s high incidence of stroke. On the survival statistics, the survival rate of CABG group is highest.3. Incomplete revascularization group is significantly higher than complete revascularization Group with CTO lesions. Most patients with acute myocardial infarction is complete revascularization, old myocardial infarction are treated with CABG. Incomplete revascularization cause higher incidence of MACCE, result in survival rates of decline, survival analysis shows incomplete revascularization are independent risk factors for MACCE.4. SYNTAX score and age, BMI, high blood pressure, diabetes, there is a positive correlation (p<0.05), but sex, smoking history, history of alcohol intake, family history of coronary heart disease, myocardial infarction and cerebral vascular illness, kidney illness history does not have a relationship with SYNTAX score.5. Age, BMI, smoking history, family history of coronary heart disease, hypertension history, history of diabetes, history of myocardial infarction are independent risk factors for MACCE, more effects including hypertension and diabetes. FBG, TC, LDL-C, LP(a), UA, FIB, LVEF, LVEDd and SYNTAX score are independent risk factors for MACCE, and left main coronary artery disease, anterior descending artery lesion in the proximal, three-vessel, incomplete revascularization are independent risk factors of MACCE.