Tomai F. J Interv Cardiol. 2019 Jun 20;2019:8586927.
Multisite artery disease (MSAD) is the concurrent existence of clinically pertinent atherosclerotic lesions in at least two crucial vascular territories. Patients with MSAD are frequently seen in clinical practice and their prediction is poorer than patients with just one territory affected. Specifically, patients with coexisting coronary artery disease (CAD) and carotid obstructive disease (COD), surgical, endovascular, or hybrid strategies were executed for revascularization as they represent complex and high-risk population. The FRIENDS observational registry accumulated data from 4 high-volume centers of patients proficient for the therapy of MSAD. The 30-day and 1-year consequences of different revascularization strategies were reported previously in patients with coexistent CAD and COD. Tomai F. et al., conducted a study to outline the long-term outcome of these patients and an inclination matching of the different treatment groups.
In the FRIENDS registry, 1022 successive patients with concomitant CAD and COD appropriate for endovascular, surgical or hybrid revascularization in one or both territories have been enrolled in the 4 hospitals during January 2006 and December 2012. Pre-specified primary outcomes were the 5-year incidence of major cardiac and cerebrovascular events (MACCE), incorporating cardiovascular death, myocardial infarction (MI), or stroke, according to the three different revascularization strategies of the evaluation. Secondary endpoints were the 5-year incidence of the individual components of the primary endpoint, any death and chronic kidney disease (CKD) or requirement of hemodialysis.
In the FRIENDS database, all clinical and procedural data were eventually enrolled and retroactively evaluated. 92% of patients completed follow-up. 554 of the patients (54.2%) being followed up for at least 5 years with median follow-up was 62.1 months. OMT incorporating statins were received at maximum tolerated dose (81%), beta-blockers (74%), and ACE inhibitors or angiotensin receptor inhibitors (65%) in the majority of cases of patients; only 12% of patients were treated with nitrates to control symptoms.
In the overall population, the cumulative occurrence of 5-year MACCE was 12%. In particular, cardiovascular death, MI, and stroke were seen in 7.4%, 4.7%, and 2.2% of patients, respectively. The overall occurrence of incidents was 21.2%, including any death (13.6%), CKD or hemodialysis (7.0%), MI (4.7%), and stroke (2.2%). The occurence of 5-year MACCE was not substantially different in the surgical, endovascular or hybrid patients group (10.1% vs.13.0% vs. 13.2%, p = .257, respectively). The hybrid group showed higher rates of myocardial infarction and CKD/haemodialysis as compared to the surgical group (p = .02; and p = .02; respectively). Also hybrid group showed greater cumulative incidence of all clinical events as compared to the surgical group (p = .006). (Figure 1)
Figure 1: Kaplan-Meier curves for the 5-year primary and secondary endpoints. The Kaplan-Meier curves for the 5-year primary and secondary endpoints are shown for the 3 approaches. Blue lines represent the surgical group (1), green lines the endovascular group, (2) and orange lines the hybrid group (3).
Thus, it was concluded that favourable consequences were shown with individualized revascularization approach of patients with combined CAD and COD at long-term follow-up, in spite of the high risk of the multilevel population even if the baseline clinical characteristics are balanced.
