Coronary Artery Bypass Grafting Versus Percutaneous Coronary Interventions in Stable Patients with Three Vessel Coronary Artery Disease, Low Syntax Score and Impaired Systolic Function

Document Type : Original Article


The Departments of Cardiac Surgery* and Cardiology**, National Heart Institute, Egypt


Abstract Background: There is no consensus regarding the selection of the coronary revasclarization procedure either PCI or CABG, many publications have addressed this issue. Usually, complete revascularization with lesser morbidities and mor-talaties is the aim, however many scoring systems, predictors, and clinical factors changed the treatment strategies. Coronary atherosclerosis is a major worldwide health problem. In December 2020 the World Health Organization (WHO) stated that atherosclerosis is the main cause of death worldwide as it affects cerebral and coronary blood vessels causing fatal stroke and myocardial infarction. Treatment of coronary artery disease includes conservative medical therapy in mild non-obstructive coronary lesions and revascularization with Cor-onary artery bypass grafting or percutaneous coronary inter-ventions in cases of severe coronary stenosis. In cases of severely stenotic multivessel coronary artery disease patients who have chronic coronary syndromes, revascularization with either percutaneous coronary intervention (PCI) or Coronary Artery Bypass Grafting (CABG) surgery is indicated. The European Society of Cardiology (ESC) /European Association of Cardiothoracic Surgery (EACTS) guidelines for coronary revascularization stated that in cases with low Syntax score less than 0 to 22, both PCI with multivessel stenting and CABG surgery are indicated with Class I, level of evidence A recommendation. Impaired left ventricular systolic function with an Ejection fraction below 40% favours CABG. Patients with stable coronary artery disease and low syntax scores may be treated by both treatment options. Although impaired systolic function favours CABG surgery, sometimes PCI is performed because of patient preference and/or Heart team discussion. Aim of Study: In our study, we compared both treatment strategies CABG versus PCI in cases with chronic coronary syndromes who have significant three-vessel coronary artery disease, low Syntax score between 0-22 and impaired systolic function with left ventricular ejection fraction below 40%. Patients and Methods: Our Patients with CAD were randomly assigned to PCI or CABG. This pre-specified analysis presents the 6 months outcomes of patients (n=80). There were no major adverse cardiac and cerebrovascular events (MACCE) in both groups, surgery consumed more time performing their procedure, and ended up by a significantly better EF in the 6 months followup of the patients. Results: It is a prospective study, where patients are divided into two groups: Group A consisted of 30 patients who were treated with Coronary artery bypass graft surgery (CABG), Group B consisted of 50 patients who were treated with Percutaneous coronary Intervention (PCI). The study endpoints were major Adverse Cardiovascular Events (Death, nonfatal stroke, nonfatal myocardial infarction), repeat revas-cularization, major bleeding. All patients will be reassessed at the immediate post-operative, and at 6 months after the revascularization procedure. Conclusion: 6 months follow-up results of patients with low SYNTAX scores, PCI is an acceptable revascularization strategy, with worse long term left ventricular function, which is a landmark for repeat investigations and repeat revascular-ization. Topic: Percutaneous coronary intervention coronary artery bypass surgery low syntax, MACCE. Issue Section: Coronary artery disease.