Optimal Management of Patients with Severe Coronary Artery Disease following Multidisciplinary Heart Team Approach—Insights from Tertiary Cardiovascular Care Center
Abstract
:1. Introduction
2. Methods and Study Design
3. Statistical Analysis
4. Results
4.1. Study Population and Baseline Characteristics
4.2. Medications at Discharge
4.3. Endpoints
4.4. Quality of Life
4.5. Logistic Regression Analysis
5. Discussion
6. Conclusions
Limitations
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Baseline Characteristic | Overall (1286) | CABG (356) | PCI (679) | OMT (251) | p-Value |
---|---|---|---|---|---|
Age, years; mean (SD) | 69.0 (10.0) | 66.9 (9.2) | 68.8 (10.1) | 72.5 (9.9) | <0.01 |
Gender, male (%) | 963 (74.9) | 289 (81.2) | 495 (72.9) | 179 (71.3) | <0.01 |
BMI, kg/m2; mean (SD) | 27.9 (3.5) | 27.9 (3.3) | 28.2 (3.7) | 27.2 (3.0) | <0.01 |
Clinical Presentation | |||||
ACS, n (%) | 526 (40.9) | 152 (42.7) | 285 (42.0) | 89 (35.5) | 0.14 |
Cardiogenic shock, n (%) | 44 (3.4) | 4 (1.1) | 29 (4.3) | 11 (4.4) | 0.02 |
Heart Failure, n (%) | 965 (75.0) | 236 (66.3) | 498 (73.3) | 231 (92.0) | <0.01 |
LV dysfunction (EF < 50%), n (%) | 1067 (83.0) | 289 (81.2) | 567 (83.5) | 211 (84.1) | 0.56 |
LV dysfunction (EF < 30%), n (%) | 336 (26.1) | 46 (12.9) | 147 (21.6) | 143 (57.0) | <0.01 |
LVEDD, cm (SD) | 5.8 (1.0) | 5.5 (0.9) | 5.8 (1.0) | 6.2 (1.0) | <0.01 |
NYHA class III-IV, n (%) | 441 (34.3) | 95 (26.7) | 217 (32.0) | 129 (51.4) | <0.01 |
CCS class III-IV, n (%) | 518 (40.3) | 165 (46.3) | 266 (39.2) | 87 (34.7) | 0.01 |
Diabetes, n (%) | 393 (30.6) | 98 (27.5) | 219 (32.3) | 76 (30.3) | 0.29 |
Requiring insulin, n (%) | 131 (10.2) | 29 (8.1) | 76 (11.2) | 26 (10.4) | 0.30 |
Hypertension, n (%) | 1068 (83.0) | 291 (81.7) | 577 (85.0) | 200 (79.7) | 0.12 |
Previous stroke/TIA, n (%) | 112 (8.7) | 26 (7.3) | 60 (8.8) | 26 (10.4) | 0.42 |
Atrial fibrillation, n (%) | 351 (27.3) | 67 (18.8) | 189 (27.8) | 95 (37.8) | <0.01 |
Previous MI, n (%) | 615 (47.8) | 189 (53.1) | 319 (47.0) | 107 (42.6) | 0.03 |
Previous PCI, n (%) | 382 (29.7) | 91 (25.6) | 217 (32.0) | 74 (29.5) | 0.10 |
Previous CABG, n (%) | 115 (8.9) | 20 (5.6) | 71 (10.5) | 24 (9.6) | 0.03 |
PAD, n (%) | 78 (6.1) | 14 (3.9) | 49 (7.2) | 15 (6.0) | 0.11 |
Carotid AD, n (%) | 133 (10.3) | 34 (9.6) | 77 (11.3) | 22 (8.8) | 0.44 |
CKD, n (%) | 463 (36.0) | 66 (18.5) | 204 (30.0) | 193 (76.9) | <0.01 |
Anaemia, n (%) | 428 (33.3) | 89 (25.0) | 182 (26.8) | 157 (62.5) | <0.01 |
Dyslipidemia, n (%) | 1028 (79.9) | 284 (79.8) | 556 (81.9) | 188 (74.9) | 0.06 |
COPD, n (%) | 129 (10.0) | 29 (8.1) | 70 (10.3) | 30 (12.0) | 0.29 |
Severe PH, n (%) | 125 (9.7) | 17 (4.8) | 73 (10.8) | 35 (13.9) | <0.01 |
Cancer, n (%) | 215 (16.72) | 22 (6.2) | 104 (15.3) | 89 (35.5) | <0.01 |
Current smoking, n (%) | 234 (18.2) | 65 (18.3) | 132 (19.4) | 37 (14.7) | 0.26 |
Frailty, n (%) | 261 (20.3) | 9 (2.5) | 89 (13.1) | 163 (64.9) | <0.01 |
Angiographic Characteristics | |||||
No. of lesions, mean (SD) | 4.2 (1.5) | 4.2 (1.4) | 4.3 (1.5) | 3.8 (1.4) | <0.01 |
LM disesase (LM stenosis ≥ 50%), n (%) | 313 (24.3) | 109 (30.6) | 158 (23.3) | 46 (18,3) | <0.01 |
Bifurcation, n (%) | 927 (72.1) | 261 (73.3) | 491 (72.3) | 175 (69.7) | 0.61 |
CTO, n (%) | 305 (23.7) | 77 (21.6) | 164 (24.2) | 64 (25.5) | 0.50 |
SYNTAX score; mean (SD) | 30.2 (6.3) | 31.1 (5.9) | 29.6 (6.5) | 30.6 (6.1) | <0.01 |
Complete revascularization, n (%) | 630/1035 (60.9) | 233 (65.4) | 397 (58.5) | - | 0.03 |
EuroSCORE II, %; mean (SD) | 5.5 (1.7) | 3.9 (1.1) | 6.0 (1.4) | 6.5 (1.5) | <0.01 |
STS score, %; mean (SD) | 3.5 (1.2) | 2.5 (0.8) | 3.9 (1.0) | 4.2 (1.1) | <0.01 |
Time to procedure, days (SD) | 5.7 (2.3) | 8.4 (1.3) | 4.2 (0.9) | - | <0.01 |
Medication at Discharge, n (%) | Overall (1233) | CABG (339) | PCI (654) | OMT (240) | p-Value |
---|---|---|---|---|---|
Aspirin | 1150 (93.3) | 302 (89.1) | 631 (96.5) | 217 (90.4) | <0.01 |
P2Y12 inhibitors | 740 (60.0) | 71 (20.9) | 635 (97.1) | 34 (14.2) | <0.01 |
Vitamin K antagonist (VKA) | 68 (5.5) | 29 (8.6) | 23 (3.5) | 16 (6.7) | <0.01 |
Novel oral anticoagulants (NOAC) | 335 (27.2) | 52 (15.3) | 186 (28.4) | 97 (40.4) | <0.01 |
Statin | 1135 (92.1) | 294 (86.7) | 628 (96.0) | 213 (88.8) | <0.01 |
ACE inhibitor | 853 (69.2) | 206 (60.8) | 479 (73.2) | 168 (70.0) | <0.01 |
Angiotensin II-receptor antagonist | 278 (22.5) | 85 (25.1) | 144 (22.0) | 49 (20.4) | 0.37 |
Beta-blocker | 952 (77.2) | 270 (79.6) | 528 (80.7) | 154 (64.2) | <0.01 |
Calcium-channel blocker | 294 (23.8) | 71 (20.9) | 157 (24.0) | 66 (27.5) | 0.19 |
Loop diuretic | 875 (71.0) | 228 (67.3) | 434 (66.4) | 213 (88.8) | <0.01 |
Aldosterone antagonist | 396 (32.1) | 43 (12.7) | 187 (28.6) | 166 (69.2) | <0.01 |
Amiodarone | 75 (6.1) | 27 (8.0) | 28 (4.3) | 20 (8.3) | 0.02 |
Endpoints, n (%) | CABG (356) | PCI (679) | OMT (251) | p Value Overall | CABG vs. PCI HR [95% CI]; p | CABG vs. OMT HR [95% CI]; p | PCI vs. OMT HR [95% CI]; p |
---|---|---|---|---|---|---|---|
Primary Endpoint—MACCE | 110 (30.9) | 302 (44.5) | 154 (61.4) | <0.01 | <0.01 | <0.01 | <0.01 |
Secondary Endpoints | |||||||
All-cause mortality, stroke, or MI | 69 (19.4) | 136 (20.0) | 139 (55.4) | <0.01 | 0.80 | <0.01 | <0.01 |
All-cause mortality | 32 (9.0) | 75 (11.0) | 72 (28.7) | <0.01 | 0.30 | <0.01 | <0.01 |
CV death | 24 (6.7) | 64 (9.4) | 43 (17.1) | <0.01 | 0.14 | <0.01 | <0.01 |
In-hospital mortality | 17 (4.8) | 25 (3.7) | 11 (4.4) | 0.68 | 0.40 | 0.82 | 0.62 |
MI | 29 (8.1) | 78 (11.5) | 48 (19.1) | <0.01 | 0.09 | <0.01 | <0.01 |
Stroke | 21 (5.9) | 14 (2.1) | 24 (9.6) | <0.01 | <0.01 | 0.09 | <0.01 |
Disabling stroke | 13 (3.7) | 6 (0.9) | 15 (6.0) | <0.01 | <0.01 | 0.18 | <0.01 |
Repeat/need for revascularization | 38 (10.7) | 165 (24.3) | 19 (7.6) | <0.01 | <0.01 | 0.20 | <0.01 |
CABG | 9 (2.5) | 17 (2.5) | 0 (0.0) | 0.04 | 0.98 | 0.01 | 0.01 |
PCI | 29 (8.1) | 148 (21.8) | 19 (7.6) | <0.01 | <0.01 | 0.80 | <0.01 |
Graft occlusion or stent thrombosis | 20 (5.6) | 40 (5.9) | 0.86 | ||||
Acute (at ≤1 day) | 2 (0.6) | 5 (0.7) | 0.75 | ||||
Subacute (within 2–30 days) | 3 (0.8) | 13 (1.9) | 0.18 | ||||
Late (within 31–365 days) | 9 (2.5) | 8 (1.2) | 0.10 | ||||
Very late (≥366 days) | 6 (1.7) | 14 (2.1) | 0.68 | ||||
Postprocedural hospital stay, days; mean (SD) | 9.9 (1.4) | 4.3 (0.7) | <0.01 |
Component | CABG (356/324) | PCI (679/604) | OMT (251/179) | p-Value |
---|---|---|---|---|
Physical Component Summary (PCS) | ||||
Before CABG, PCI, MHT disscusion; mean (SD) | 71.1 (18.6) | 73.2 (18.4) | 73.8 (15.8) | 0.12 |
After CABG, PCI, MHT disscusion—at the end of follow up; mean (SD) | 62.0 (17.0) | 65.7 (14.3) | 75.0 (15.9) | <0.01 |
Mental Component Summary (MCS) | ||||
Before CABG, PCI, MHT disscusion; mean (SD) | 51.6 (9.4) | 52.0 (9.4) | 52.5 (9.0) | 0.53 |
After CABG, PCI, MHT disscusion—at the end of follow up; mean (SD) | 43.3 (9.4) | 44.9 (9.7) | 53.3 (8.9) | <0.01 |
Total | ||||
Before CABG, PCI, MHT disscusion; mean (SD) | 122.8 (20.2) | 125.2 (20.6) | 126.3 (18.7) | 0.07 |
After CABG, PCI, MHT disscusio—at the end of follow up; mean (SD) | 105.3 (18.8) | 110.7 (16.8) | 128.3 (19.5) | <0.01 |
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Jonik, S.; Marchel, M.; Pędzich-Placha, E.; Pietrasik, A.; Rdzanek, A.; Huczek, Z.; Kochman, J.; Budnik, M.; Piątkowski, R.; Scisło, P.; et al. Optimal Management of Patients with Severe Coronary Artery Disease following Multidisciplinary Heart Team Approach—Insights from Tertiary Cardiovascular Care Center. Int. J. Environ. Res. Public Health 2022, 19, 3933. https://doi.org/10.3390/ijerph19073933
Jonik S, Marchel M, Pędzich-Placha E, Pietrasik A, Rdzanek A, Huczek Z, Kochman J, Budnik M, Piątkowski R, Scisło P, et al. Optimal Management of Patients with Severe Coronary Artery Disease following Multidisciplinary Heart Team Approach—Insights from Tertiary Cardiovascular Care Center. International Journal of Environmental Research and Public Health. 2022; 19(7):3933. https://doi.org/10.3390/ijerph19073933
Chicago/Turabian StyleJonik, Szymon, Michał Marchel, Ewa Pędzich-Placha, Arkadiusz Pietrasik, Adam Rdzanek, Zenon Huczek, Janusz Kochman, Monika Budnik, Radosław Piątkowski, Piotr Scisło, and et al. 2022. "Optimal Management of Patients with Severe Coronary Artery Disease following Multidisciplinary Heart Team Approach—Insights from Tertiary Cardiovascular Care Center" International Journal of Environmental Research and Public Health 19, no. 7: 3933. https://doi.org/10.3390/ijerph19073933