Single centre analysis of revascularization strategy in Newfoundland and Labrador multivessel disease patients

Vasanthan, Kieran (2020) Single centre analysis of revascularization strategy in Newfoundland and Labrador multivessel disease patients. Masters thesis, Memorial University of Newfoundland.

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Abstract

Background: Coronary artery disease (CAD) can be managed with Percutaneous Coronary Intervention (PCI) or Coronary Artery Bypass Grafting (CABG). Management of subtypes of CAD, including Multivessel Disease (MVD) and isolated Left Main Coronary Artery (LMCA) disease, continue to evolve in the literature. An observational registry may provide implications for management of CAD. Methods: All isolated LMCA and triple-vessel disease patients who received either PCI or CABG in Newfoundland & Labrador (NL) were analyzed in two separate studies. The first study evaluated isolated LMCA patients for freedom from Major Adverse Cardiac Events (MACE). The second study evaluated triple vessel disease patients for in-hospital mortality post revascularization. Results: Firstly, 115 patients with isolated LMCA disease (n=7 PCI, n=99 CABG, n=9 medical management) were identified from May 2006 to October 2015. The rate of MACE at 1 year was 5.1% in the CABG cohort. Secondly, a total of 1604 triple vessel disease patients (n=45 PCI, n=1559 CABG) were analyzed with a median follow up of 5.4 years. The in-hospital mortality rate was 2.2% and 1.2% in the PCI and CABG cohorts, respectively (p=0.533). Conclusion: CABG represented the most common revascularization strategy for both study populations. Freedom from MACE at one year in the CABG isolated LMCA patients was comparable to the literature. Early survival rates were comparable in low-risk triple vessel disease patients revascularized with either therapy and further evaluation is warranted to account for an increasing number of this population being revascularized via PCI.

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