Abstract Number: PB0019
Meeting: ISTH 2021 Congress
Background: Presently, there are no established consensus and adequate data for optimal coronary revascularization strategy for complex CAD patients with prior stroke.
Aims: The study aims to determine whether high-risk patients with three-vessel disease (TVD) with and without prior stroke preferentially benefit from three strategies [percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), and medical therapy (MT)].
Methods: A total of 8,943 patients with TVD were included. Patients were stratified into 2 categories according to presence or absence of prior stroke. The primary endpoint was all-cause death. Secondary endpoints included stroke and major adverse cardiac and cerebrovascular events (MACCE), a composite of death, myocardial infarction, unplanned revascularization and stroke.
Results: Prior stroke was present in 888 of 8,943 patients (9.9%). During a median follow-up of 7.5 years, patients with prior stroke were strongly associated with increased risks of all-cause death, cardiac death, stroke and MACCE (all adjusted p < 0.01). Patients with prior stroke was strongly associated with increased MACCE compared with no prior stroke driven by higher rates of all-cause mortality and stroke, prior stroke was the independent risk factor of all-cause death, stroke and MACCE after adjusting for confounding variables. Revascularization strategy (PCI or CABG) was associated with a lower incidence of all-cause death and MACCE compared with MT alone, CABG showed lower risk of MACCE and similar risk of all-cause death compared with PCI irrespective of prior stroke. The prevalence of stroke was significantly higher after CABG when compared with PCI or MT among no prior stroke patients (HR 1.429, 95%CI 1.132-1.805 for CABG vs.MT, HR 1.703, 95%CI 1.371-2.116 for CABG vs. PCI).
Conclusions: Patients with TVD and prior stroke have poor long-term outcomes. It is essential to balance benefit and risk when determining optimum revascularization strategy for TVD with and without prior stroke.
To cite this abstract in AMA style:Xu N, Jiang L, Zhang C, Xu J, Liu R, Zhang Y, Zhao X, Gao R, Song L, Yuan J. Long-term Outcome of Percutaneous or Surgical revascularization with and without Prior Stroke in patients with Three-vessel Disease [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/long-term-outcome-of-percutaneous-or-surgical-revascularization-with-and-without-prior-stroke-in-patients-with-three-vessel-disease/. Accessed October 19, 2021.
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