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@#Objective To evaluate the early and mid-term results of robot-assisted coronary artery bypass grafting (RACAB) in the treatment of multi-vessel coronary artery disease (MV-CAD). Methods Patients with MV-CAD who underwent RACAB from April 2018 to December 2021 in our hospital were included. Patients who underwent hybrid coronary revascularization (HCR) which combined RACAB with percutaneous coronary intervention were allocated to a HCR-RACAB group, and patients who underwent multi-vessel RACAB were allocated to a MV-RACAB group. Perioperative and follow-up data were collected and compared between the two groups. Results A total of 102 patients were included, including 81 males and 21 females with a mean age of 61.7±10.8 years. Two (2.0%) patients were transferred to conventional CABG due to sudden ventricular fibrillation and pleura adhesion. In the remaining 100 patients who underwent RACAB, 100 left internal mammary arteries (LIMA) and 46 right internal mammary arteries (RIMA) were harvested with a 100.0% success rate. Besides, all patients undergoing RACAB achieved LIMA/RIMA-left anterior descending branch reconstruction, with an average number of 2.5±0.6 target vessels revascularized by stent or graft. One patient had perioperative myocardial infarction with an outcome of death. The incidence of major perioperative adverse events was 1.0%. There was no perioperative stroke or re-sternotomy for hemostasis. The mean follow-up time was 28.2 months, with a follow-up rate of 99.0% and an overall major adverse cardiac and cerebrovascular event (MACCE) rate of 7.0%, including 3 all-cause deaths (3.0%), 2 strokes (2.0%) and 3 re-revascularizations (3.0%). The HCR-RACAB group had fewer red blood cell transfusion (P=0.030) and intraoperative blood loss (P=0.037) compared with the MV-RACAB group, and there was no statistical difference in the incidence of major perioperative adverse events or MACCE between the two groups during the follow-up period (P>0.05). Conclusion RACAB can be safely applied in the treatment of MV-CAD with good early and mid-term outcomes. High-quality harvesting of LIMA/RIMA and aortic no-touch technique are crucial to achieve these results.
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Background: The present study evaluated the changes in baseline left ventricular function and clinical symptoms in multi-vessel coronary artery disease patients after multi-vessel percutaneous coronary intervention.Methods: This was a prospective, observational study conducted at Medical Super-speciality Hospital, Kolkata, India, between August 2017 and August 2019. The study included 48 patients who were diagnosed with ≥2 coronary artery stenosis of ≥50% in native coronary arteries with left ventricular ejection fraction (LVEF) <40%. Echocardiography was performed before and after 3 months of the procedure to observe LVEF. Canadian Cardiovascular Society (CCS) score was calculated before and after 3 months after PCI.Results: Mean age of the patients was 61.89±9.96 years and 89.6% patients were male. Mean LVEF before and after angioplasty was 34.9±4.95% and 42.06±8.78%, respectively (p=0.001). CCS score before and after angioplasty was 2.89 and 1.83, respectively (p=0.001).Conclusions: The results displayed significant improvement in clinical symptoms as well as LVEF after PCI in patients with multi-vessel disease with LVEF <40%. These results will be helpful to conduct larger randomized trials with long term follow-up in order to prove the safety and effectiveness of PCI in such patients over coronary artery bypass grafting.
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Objective To explore the effect of drug-eluting stent (DES) implantation for early non-culprit vessel's revascularization on the prognosis of acute ST-segment elevation myocardial infarction (STEMI) patients presenting with multivessel disease (MVD) after percutaneous coronary intervention (PCI). Methods A total of 212 selected patients, admitted in the First Affiliated Hospital of Chongqing Medical University from Jan. 1, 2016 to Jul. 30, 2018, diagnosed as STEMI with MVD undergoing emergency PCI treatment, were recruited in present single-center retrospective study. According to the treatment strategy, all the subjects were then divided into control group (n=153) and experimental group (n=59). Patients in control group received culprit vessel emergency PCI only, and those in experimental group underwent early non-culprit vessel's DES revascularization (Within 14 days of hospitalization) after culprit vessel's PCI. The incidence of major adverse cardiovascular events (MACE, a composite endpoint of cardiac death, recurrent myocardial infarction, ischemia-driven revascularization and heart failure) and safety end point events within 12 months after PCI were compared between the two groups. The influencing factors for MACE were analyzed by logistic regression. Results The incidence of MACE was significantly lower in treatment group than that in control group 12 months after PCI (5.1% vs. 22.2%, P=0.006). No significant statistical difference existed between the two groups in all-cause mortality (0% vs. 5.1%), malignant angina pectoris (1.7% vs. 7.8%), contrast nephropathy (3.4% vs. 2.6%), gastrointestinal bleeding (0% vs. 5.1%), and stroke (3.4% vs. 0.7%). Logistic regression showed that the control group (only received culprit vessel PCI) and prolonged operation time were the risk factors for MACE. Conclusion Early revascularization of non-culprit vessel is safer than only culprit vessel PCI, can reduce the incidence of MACE, improves the prognosis, and reduces hospitalization rates within the 12 months after PCI in acute STEMI patients with MVD.
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Objective To investigate the effect of percutaneous coronary intervention (PCI) guided by blood flow reserve score (FFR) on the prognosis of patients with acute coronary syndrome (ACS) with multiple vessel lesions.Methods From April 2015 to April 2017,three hundred and twenty patients with ACS complicated with multi-vessel disease in the Department of Cardiology,Shanghai Tenth People's Hospital were randomly divided into two groups,160 cases in each group.Flow reserve fraction (FFR) and coronary arteriography alone (CAG) were used to guide PCI treatment (CAG group).The basic data,the success rate of PCI and the number of stent implantation were compared between the two groups.The patients were followed up for 6 months and the incidence of major adverse cardiovascular events (MACE) was compared between the two groups.Results There was no significant difference in sex,age,type of lesion,risk factors,coexisting diseases,number of lesion vessels and preoperative left ventricular ejection fraction (LEVF) between the two groups (P＞0.05).There were no significant differences in the success rate of PCI between FFR group and CAG group (97.7％ (127/130) vs.(99.2％ (129/130)),the time of PCI operation ((95.43±36.24) min vs.(101.36±28.16) min),the length of hospitalization ((6.12±1.74) d vs.(5.94± 1.55) d) ((x2 =1.02,t =1.47,t =1.01,P＞0.05).Compared with CAG group,the number of stents in FFR group ((1.79±0.25) vs.(2.15±0.34)),the amount of contrast agent ((143.42±27.42) ml vs.(184.11± 31.05) ml) were significantly reduced (t =9.73,t =11.22,P ＜ 0.05).Six months after operation,the incidence of target vessel revascularization and major adverse cardiovascular events in FFR group was 3.1％ (4/130).The total incidence of major adverse cardiovascular events was 6.9％ (9/130),significantly lower than that of CAG group (9.2％ (12/130) vs.16.2％ (21/130).The difference was statistically significant (x2 =4.26,x2 =5.43,P ＜ 0.05).Conclusion FFR-guided PCI can reduce unnecessary stent implantation,reduce major adverse cardiovascular events and improve the prognosis of ACS patients with multi-vessel disease.
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Objective To explore the clinical feasibility and safety of early intervention for severe stenosis of non-infarct related artery(non-IRA)in patients with acute ST-segment elevation myocardial infarction(STEMI) and multi-vessel disease(MVD)after successful primary percutaneous coronary intervention(PCI)for infarct-asso-ciated artery(IRA). Methods From May 1st,2011 to December 30th,2016,165 patients with STEMI and MVD were enrolled in our study. After the completion of primary PCI in IRA ,75 patients still in the hospital agreed to undergo a second staged PCI in severe stenosis of non-infarct arteries. We analyzed the in-hospital adverse events ,the length of hospital stay and clinical outcomes during the follow-up in the study population. Results There was no significant difference in the incidence of adverse events between the two groups during hos-pitalization. However,compared to patients treated with the IRA-only PCI,those treated with early intervention for severe stenosis of non-IRA was associated with greater benefits for clinical outcomes(including rehospitalization for heart failure,rehospitalization for ACS,recurrent angina pectoris,necessity for reintervention)during the follow-up except for the all-cause mortality. Conclusion Early intervention for severe stenosis of non-IRA is a feasible and safe procedure in patients with acute STEMI and MVD after successful primary PCI.