Why the study?
Non-optimal long-term results of bare metal stents and their wide use in Russia prompted evaluation of how prior bare metal stenting affects subsequent CABG outcomes in patients with ACS and multivessel disease.
Does stenting with bare metal stents followed by CABG increase the risk of MACCE compared to 2nd generation drug-eluting stents in patients with ACS and multivessel disease?
Does stenting with bare metal stents followed by CABG increase the risk of MACCE compared to 2nd generation drug-eluting stents in patients with ACS and multivessel disease?
Stepwise treatment with bare metal stenting followed by CABG in ACS patients with multivessel disease is associated with a higher risk of adverse events compared to treatment with 2nd generation drug-eluting stents.
Prior bare metal stenting in ACS may complicate subsequent CABG; leaves open optimal strategy in multivessel disease.
Non-optimal long-term results of endovascular interventions using bare metal stents and their wide use in Russia in acute coronary syndrome (ACS) make it important to study the influence of the mentioned interventions on the results of coronary artery bypass graft surgery (CABG) performed after stenting of the obstructed artery in patients with ACS and multivessel disease. Aim. To study the results of CABG performed at our department in early periods of ACS after stenting of an obstructed artery with bare metal stents versus the results of use of drug coated stents of the 2nd generation, on the basis of the data of NORSTENT study. Materials and Methods. The work presents the results of a two-year observation of stepwise treatment of 97 patients with ACS and multivessel disease who were performed stenting of an obstructed artery for life-saving indications followed by CABG not later than in 90 days. Patients of the main group had three-vessel disease of coronary arteries with severity of damage 26.03.2 points on SYNTAX scale. The time from the moment of stenting to complete revascularization was 6417 days. Clinico-demographic parameters of the main group were comparable with those of the comparison group (data of NORSTENT study). Results. During observation time two cases of acute myocardial infarction occurred. Repeat revascularization was required in 14 patients (14.4%). The rate of MACCE was 0.1443. Odd ratio (OR) of the risk of MACCE occurrence was 1.61 (95% CI [1.14;2.78]). Conclusion. Surgical revascularization of the coronary bed in early periods after stenting of the obstructed artery with bare metal stents in patients with ACS and multivessel disease has 1.6 times (95% CI 1.14;2.78) higher risk for initiation of adverse cardiovascular events, in comparison with endovascular revascularization with use of drug coated stents of the 2nd generation.
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А. В. Бочаров (2020) studied this question.
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