Surgery, Percutaneous Intervention, and Medical Treatment in Cases with Chronic Coronary Syndrome with High Syntax Scores

Öz

Generally, surgical revascularization recommended for patients who have high SYNTAX scores, but it is the greatest desire of invasive cardiologists to have a reliable “Plan B” in cases with high surgery risk. For this reason, the purpose of the present study was to compare medical treatment alone, surgical-medical treatment, and percutaneous-medical treatment options in CCS cases with a SYNTAX score of ≥33. In an observational registry study, we included patients with multivessel disease and SYNTAX score of ≥33. Both short (30-day) and long-term outcomes of subjects in all three treatment arms were evaluated. The primary outcome was allcause and cardiac mortality. Myocardial infarction, revascularization, and stroke constituted our secondary outcomes. 33 patients in the MT arm, 24 in the PCI arm, and 79 in the CABG arm were included in the analyses. Mean follow-up was 48.25±26.37 months. CABG arm was superior to both arms in terms of cardiac death (CABG vs MT p=0.001, CABG vs PCI p=0.001) and PCI and MT did were similar (p=0.085), CABG was superior in allcause detah (CABG vs MT p=0.002, CABG vs PCI p=0.002) again no statistical differences were detected between MT and PCI arms (p=0.065) in long term follow-up. In terms of acute myocardial infarction(AMI) (CABG vs MT p=<0.001, CABG vs PCI p=<0.001), cerebrovascular event(CVE) (CABG vs MT p=0.04, CABG vs PCI p=0.015) , additional revascularization CABG was superior side again (CABG vs PCI p=<0.001). AMI was higher in MT group compare to PCI (p=0.025). CVE were similar in MT and PCI groups (p=0.65). İn cases with CCS and ≥33 SYNTAX score, CABG is superior to MT alone and PCI which is performed with everolimus-eluting stents in terms of cardiac death, allcause mortality, AMI and CVE in long term follow-up.

Anahtar Kelimeler

• Coronary artery bypass
• Everolimus
• Percutaneous coronary intervention
• SYNTAX score
• Multivessel disease

Yüksek Syntax Skoruna Sahip Kronik Koroner Sendromlu Olgularda Cerrahi, Perkütan Müdahale ve Medikal Tedavi

Öz

Yüksek SYNTAX skorlu olgulara genellikle cerrahi revaskülarizasyon önerilmektedir ve cerrahi riski yüksek olgularda güvenilir bir “B planı”nın olması girişimsel kardiologların en büyük arzusudur. Bu sebeple çalışmamızda kronik koroner sendrom (KKS)’lu SYNTAX skoru ≥33 olan olgularda tek başına medikal tedavi(MT), cerrahi-medikal tedavi(CABG) ve perkütan-medikal tedavi(PCI) kollarını karşılaştırmayı amaçladık. Gözlemsel kayıt çalışmamıza KKS’li çok damar hastası ve SYNTAX skoru ≥33 olan olgular dahil edildi. Her üç tedavi kolundaki olguların hem kısa (30 günlük) hem de uzun dönem sonlanımları değerlendirildi. Birincil sonlanım noktası kardiyak ve tüm nedenlere bağlı mortalite iken, ikincil sonlanım noktası akut miyokart infarktüsü(AMİ), ilave revaskülarizasyon, serebrovasküler olay( SVO) olarak belirlendi. 33 hasta MT, 24 hasta PCI, 79 hasta ise CABG kolunda istatistiksel analize dahil edildi. Ortalama takip süresi 48,25±26,37 ay olarak saptandı. Uzun dönemde CABG kardiyak ve tüm nedenlere bağlı ölüm açısından MT ve PCI kollarına üstün olduğu görüldü(sırasıyla CABG vs MT p=0,001, CABG vs PCI p=0,001; CABG vs MT p=0,002, CABG vs PCI p=0,002). Bu bağlamda MT ve PCI kolları arasında fark görülmedi (sırasıyla p=0,085, p=0,065). AMİ ve SVO sonlanım noktalarında da CABG kolunun superior olduğu saptandı(sırasıyla CABG vs MT p=<0,001, CABG vs PCI p=<0,001; CABG vs MT p=0,04, CABG vs PCI p=0,015). CABG kolu ilave revaskülarizasyon açısından da PCI’a üstün bulundu(p=<0,001). AMİ MT’de PCI koluna göre daha fazla görülürken (p=0,025), SVO açısından iki kol arasında fark görülmedi(p=0,65) daha fazl İlave revaskülarizasyon açısından da yine CABG daha üstün olarak görüldü(CABG vs PCI p=<0,001) KKS’lu SYNTAX skoru ≥33 olan olgularda CABG, tek başına MT ve everolimus kaplı stentlerle yapılan PCI’ya göre uzun dönemde kardiyak ölüm, tüm nedenlere bağlı ölüm, AMİ ve SVO açısından daha üstündür.

Anahtar Kelimeler

• Koroner bypass
• Everolimus
• Perkütan koroner müdahale
• Syntax skoru
• çok damar hastalığı.

Kaynakça

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