Reasonable Incomplete Myocardial Revascularization in Patients with Chronic Heart Failure and Reduced Left Ventricular Ejection Fraction
Abstract
The aim. To evaluate the results of incomplete myocardial revascularization with percutaneous coronary intervention (PCI) in patients with ischemic cardiomyopathy and heart failure with reduced left ventricular ejection fraction based on the residual SYNTAX Score (rSS) scale.
Materials and methods. This prospective observational one-center study was conducted at the Ukrainian Children’s Cardiac Center, Clinic for Adults and included 192 patients whounderwent coronary angiography and myocardial re-vascularization using PCI. Baseline demographic and clinical parameters, including gender, age, presence of comorbid pathology were obtained from the medical history of each patient retrospectively. The results of revascularization were evaluated over a period of 2 years (from March 2020 to March 2022). To assess the completeness of revascularization, the rSS scale was used, and coronary angiography was repeated.
Results and discussion. The most significant adverse events during 24 months of follow-up, associated with the severity of coronary artery damage according to the SYNTAX scale ≥23 points, were: death from any cause with odds ratio (OR) 6.9 (95% CI, p = 0.05); myocardial infarction (MI) with OR 5.5 (95% CI, p = 0.001); the combined endpoint was OR 2.4 (95% CI, p = 0.005). Over a 2-year follow-up period,results of myocardial revascularization according to the rSS scale were evaluated the effect of coronary artery stenting with minimal residual atherosclerotic narrowing (rSS ≤8) and significant arterial lesions (rSS ≥9) on indicators such as all-cause mortality, myocardial revascularization, re-hospitalization, recurrent acute MI and stroke were analyzed. Data analysis showed statistically significant difference in all indicators in favor of the group with a score of rSS ≤8 (р <0.05).
Conclusions. The rSS scale in patients with coronary artery disease and heart failure with reduced left ventricular ejection fraction after PCI is a statistically significant criterion for the impact on the combined endpoint. In addition, an rSS score ≥9 was associated with a significantly higher riskof all-cause mortality, recurrent acute MI, and recurrent revascularization. A stratified rSS score ≥9 in ischemic cardiomyopathy with left ventricular ejection fraction ≤40% was more often observed in patients with existing comorbid pathology, such as hypertension, diabetes mellitus, stroke, peripheral artery disease.
References
- Dauerman HL. Reasonable Incomplete Revascularization. Circulation. 2011;123(21):2337-40. https://doi.org/10.1161/CIRCULATIONAHA.111.033126
- Tajstra M, Pyka Ł, Gorol J, Pres D, Gierlotka M, Gadula-Gacek E, et al. Impact of Chronic Total Occlusion of the Coronary Artery on Long-Term Prognosis in Patients With Ischemic Systolic Heart Failure: Insights From the COMMIT-HF Registry. JACC Cardiovasc Interv. 2016;9(17):1790-7. https://doi.org/10.1016/j.jcin.2016.06.007. Erratum in: JACC Cardiovasc Interv. 2016;9(20):2181-2. Erratum in: JACC Cardiovasc Interv. 2017;10(12):1282.
- Fefer P, Knudtson ML, Cheema AN, Galbraith PD, Osherov AB, Yalonetsky S, et al. Current Perspectives on Coronary Chronic Total Occlusions: The Canadian Multicenter Chronic Total Occlusions Registry. J Am Coll Cardiol. 2012;59(11):991-7. https://doi.org/10.1016/j.jacc.2011.12.007
- Kolh P, Windecker S, Alfonso F, Collet JP, Cremer J, Falk V, et al. 2014 ESC/EACTS Guidelines on myocardial revascularization. Eur J Cardiothorac Surg. 2014;46(4):517-92. https://doi.org/10.1093/ejcts/ezu366
- Di Mario C, Werner GS, Sianos G, Galassi AR, Buttner J, Dudek D, et al. European perspective in the recanalisation of Chronic Total Occlusions (CTO): consensus document from the EuroCTO Club. EuroIntervention. 2007;3(1):30-43.
- Pyka Ł, Hawranek M, Gąsior M. Revascularization in ischemic heart failure with reduced left ventricular ejection fraction. The impact of complete revascularization. Kardiochir Torakochirurgia Pol. 2017;14(1):37-42. https://doi.org/10.5114/kitp.2017.66928
- Xue L, Guo D, Wang L, Cao C, Li Q, Zou S. Objectifying the level of incomplete revascularization by residual SYNTAX score and evaluating the impact of incomplete revascularization on exercise tolerance in patients with coronary atherosclerotic heart disease treated by percutaneous coronary intervention. Medicine (Baltimore). 2020;99(38):e22221. https://doi.org/10.1097/MD.0000000000022221
- Song Y, Gao Z, Tang X, Jiang P, Xu J, Yao Y, et al. Impact of residual SYNTAX score on clinical outcomes after incomplete revascularisation percutaneous coronary intervention: a large single-centre study. EuroIntervention. 2017;13(10):1185-93. https://doi.org/10.4244/EIJ-D-17-00132
- Fujino A, Kadohira T, Redfors B, Maehara A, Serruys PW, Mintz GS, et al. Significant association among residual SYNTAX score, non-culprit major adverse cardiac events, and greyscale and virtual histology intravascular ultrasound findings: a substudy from the PROSPECT study. EuroIntervention. 2019;14(16):1676-84. https://doi.org/10.4244/EIJ-D-18-00681
- Melina G, Angeloni E, Refice S, Benegiamo C, Lechiancole A, Matteucci M, et al. Residual SYNTAX score following coronary artery bypass grafting. Eur J Cardiothorac Surg. 2017;51(3):547-53. https://doi.org/10.1093/ejcts/ezw356
- Perera D, Clayton T, O’Kane PD, Greenwood JP, Weerackody R, Ryan M, et al.; REVIVED-BCIS2 Investigators. Percutaneous Revascularization for Ischemic Left Ventricular Dysfunction. N Engl J Med. 2022;387(15):1351-60. https://doi.org/10.1056/NEJMoa2206606.
- Velazquez EJ, Lee KL, Deja MA, Jain A, Sopko G, Marchenko A, et al.; STICH Investigators. Coronary-Artery Bypass Surgery in Patients with Left Ventricular Dysfunction. N Engl J Med. 2011;364(17):1607-16. https://doi.org/10.1056/NEJMoa1100356
