Abstract 19963: Different Patterns of Mortality Associated with Treatment Options in Late Follow-up of Stable Multivessel Coronary Artery Disease Patients.
Introduction: The therapeutic options to patients with stable multivessel coronary artery disease (CAD) and normal ventricle function are coronary artery bypass graft (CABG), angioplasty (PCI) or medical treatment (MT). The hypothetical superiority of surgery does not, however, translate into tangible benefits. All strategies present similar long-term rates of irreversible events. HYPOTESIS: This is a post-hoc analysis of Medicine, Angioplasty, or Surgery Study II (MASS II), evaluates the cause of mortality, stratifying in cardiac, noncardiac death, and in the cause of noncardiac death. Our hypothesis is that CABG promotes a greater protection of cardiac death and in contra balance a higher mortality of noncardiac causes.
Methods: It is a prospective, randomized clinical trial, designed to compare MT, PCI, and CABG in patients with stable multivessel CAD with normal ventricle function. To test our hypothesis, the patients were grouped in CABG and nonCABG group (PCI plus MT). It was collected all the mortality events and classified in cardiac or noncardiac death. In noncardiac death, we analyzed the causes of mortality.
Results: A total of 611 patients were randomly assigned to CABG (n=203), PCI (n=205) or MT (n=203). The minimal duration of follow-up was 5.5 years. No statistical differences were observed in overall mortality (P=0.824). Nevertheless, we observed a significant difference regarding the distribution of mortality causes among the CABG and nonCABG group (P=0.001). CABGgroup: Of the 203 patients, 16 (47.1%) died of cardiac causes and 18 (53.9%) died of noncardiac causes. Of these, 7 deaths (20.6%) were due to neoplasia, 4 died of sepsis, 3 due to stroke and 2 of aortic dissection, 1 died of duodenal ulcer and occupational accident. NonCABGgroup: Composed of 408 patients, 53 (80.3%) died of cardiac causes and 13 (19.7%) died of non-cardiac causes. Of these, 5 deaths (7.5%) were due to neoplasia, 3 due to stroke, 3 died of sepsis, 1 died of occupational accident and pulmonary embolism.
Conclusion: Our study suggests that different treatment options for multivessel CAD had similar overall mortality. However, CABG patients had higher incidence of noncardiac mortality, especially neoplasia.
- © 2010 by American Heart Association, Inc.