IMPACT OF MULTIVESSEL STENTING ON CARDIAC FUNCTION IN PATIENTS WITH TRIPLE VESSEL DISEASE
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Keywords
Triple Vessel Disease, Multivessel Stenting, Percutaneous Coronary Intervention, Cardiac Function, Left Ventricular Ejection Fraction, Pakistan
Abstract
Background: Triple vessel disease (TVD) is characterized by significant stenosis in all three major coronary arteries, posing a substantial risk for adverse cardiac events. Percutaneous coronary intervention (PCI), particularly multivessel stenting, has emerged as a viable alternative to coronary artery bypass grafting (CABG) due to its less invasive nature and shorter recovery time. However, the impact of multivessel stenting on cardiac function, particularly in patients with TVD in Pakistan, requires further exploration.
Objective: This study aimed to evaluate the impact of multivessel stenting on cardiac function in patients with TVD in Pakistan.
Methods: An observational study was conducted at Lady Reading Hospital, Peshawar, from January to June 2023. The study included 300 patients aged 18 years or older, diagnosed with TVD, and scheduled for elective multivessel stenting. The intervention involved performing PCI with multivessel stenting. Primary outcomes measured were changes in left ventricular ejection fraction (LVEF) post-multivessel stenting. Secondary outcomes included improvements in exercise tolerance and reduction in angina symptoms. Data were analyzed using SPSS version 25.0, with comparisons made using paired t-tests and Wilcoxon signed-rank tests.
Results: The mean age of participants was 60.4 years (SD ± 9.5). The mean LVEF improved from 45% (SD ± 7) pre-procedure to 52% (SD ± 6) post-procedure, with a median increase of 7% (p < 0.001). The mean distance covered in the six-minute walk test (6MWT) increased from 350 meters (SD ± 50) pre-procedure to 400 meters (SD ± 45) post-procedure (p < 0.01). Additionally, the frequency of angina episodes per week decreased from 4.5 (SD ± 1.2) to 1.5 (SD ± 0.8) post-procedure (p < 0.001).
Conclusion: Multivessel stenting significantly improves cardiac function, exercise tolerance, and reduces angina symptoms in patients with TVD. These findings support the use of PCI as an effective treatment strategy for this patient population, emphasizing the need for targeted interventions to optimize patient outcomes.
References
2. Mohr FW, Morice MC, Kappetein AP, et al. Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomized clinical SYNTAX trial. Lancet. 2013;381(9867):629-638.
3. Ahmad K, Jafar TH, Siddiqui MS. Prevalence and determinants of coronary artery disease in a rural population of Pakistan. J Pak Med Assoc. 2005;55(9):364-368.
4. Marso SP, Hiatt WR. Peripheral arterial disease in patients with diabetes. J Am Coll Cardiol. 2006;47(5):921-929.
5. Herzog CA, Littrell K, Arko C, et al. Clinical characteristics and outcomes of coronary artery bypass grafting patients with chronic kidney disease. J Am Soc Nephrol. 2004;15(1):285-293.
6. Yusuf S, Reddy S, Ounpuu S, et al. Global burden of cardiovascular diseases: Part I: General considerations, the epidemiologic transition, risk factors, and impact of urbanization. Circulation. 2001;104(22):2746-2753.
7. Tonino PA, De Bruyne B, Pijls NH, et al. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med. 2009;360(3):213-224.
8. Bangalore S, Kumar S, Fusaro M, et al. Short- and long-term outcomes with drug-eluting and bare-metal coronary stents: a mixed-treatment comparison analysis of 117 762 patient-years of follow-up from randomized trials. Circulation. 2012;125(23):2873-2891.
9. Park SJ, Ahn JM, Kim YH, et al. Trial of everolimus-eluting stents or bypass surgery for coronary disease. N Engl J Med. 2015;372(13):1204-1212.
10. Fihn SD, Gardin JM, Abrams J, et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease. J Am Coll Cardiol. 2012;60(24).
11. Stone GW, Sabik JF, Serruys PW, et al. Everolimus-eluting stents or bypass surgery for left main coronary artery disease. N Engl J Med. 2016;375(23):2223-2235.
12. Windecker S, Stortecky S, Stefanini GG, et al. Revascularisation versus medical treatment in patients with stable coronary artery disease: network meta-analysis. BMJ. 2014;348.
13. Morice MC, Serruys PW, Kappetein AP, et al. Outcomes in patients with de novo left main disease treated with either percutaneous coronary intervention using paclitaxel-eluting stents or coronary artery bypass graft treatment in the SYNTAX trial. Circulation. 2010;121(24):2645-2653.
14. Boden WE, O'Rourke RA, Teo KK, et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med. 2007;356(15):1503-1516.
15. Hlatky MA, Boothroyd DB, Melsop KA, et al. Comparative effectiveness of multivessel coronary bypass surgery and multivessel percutaneous coronary intervention: a cohort study. Ann Intern Med. 2013;158(10):727-734.
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