Comparative evaluation of long-term results of percutaneous coronary intervention and optimal medical therapy in patients with multivessel coronary artery disease not eligible for coronary artery bypass graft

Aim. To evaluate the long-term results of percutaneous coronary intervention (PCI) plus optimal medical therapy (OMT) and OMT alone in patients with stable chronic coronary syndrome (CCS) and multivessel coronary artery disease who were not eligible for coronary artery bypass graft surgery (CABG).
Material and methods. This retrospective study included 374 patients with stable CCS and multivessel coronary artery disease, not eligible for CABG, hospitalized between 2013 and 2022. Patients were divided into 2 groups: Group 1 conservative therapy (OMT alone) and Group 2 invasive strategy (PCI+OMT). The primary composite endpoint of the study was the incidence of major adverse cardiovascular and cerebrovascular events (MACCE). In order to balance the groups according to their initial characteristics, Propensity score matching (PSM) was performed.
Results. Out of 374 patients, 321 patients were selected after PSM: 107 into the first group and 214 into the second group. The median age of the study patients was 69 [61; 76] years in group one and 66 [60; 74] years in group two (p=0,212). The median SYNTAX score was 32 [24; 40] versus 30 [24; 37], respectively (p=0,239). Long-term outcome analysis was performed in 306 patients out of 321 (95,3%). The incidence of the primary endpoint (MAСCE) in the conservative strategy group was 64,1% versus 51,8% in the invasive strategy group, p=0,034.
Conclusion. Invasive strategy (PCI+OMT) in patients with CCS and multivessel coronary lesions and not eligible for CABG is accompanied by a high rate of procedural success and a low rate of in-hospital complications. Myocardial revascularization by PCI in this cohort of patients leads to statistically significant reduction in the incidence of MACCE and cardiac mortality in the long-term follow-up period in comparison with conservative therapy.

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