Imperial College London
Dr Nandor Marczin

DrNandorMarczin

Faculty of Medicine, Department of Surgery & Cancer

Senior Clinical Lecturer Honorary consultant
 
 
 
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Contact

 

+44 (0)1895 453 804n.marczin

 
 
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Location

 

Heart Science CentreHarefield HospitalHarefield Hospital

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Summary

 

Publications

Citation

BibTex format

@article{Cummings:2020:10.1016/j.ijsu.2020.03.008,
author = {Cummings, IG and Lucchese, G and Garg, S and Soni, M and Majid, AF and Marczin, N and Panoulas, V and Raja, SG},
doi = {10.1016/j.ijsu.2020.03.008},
journal = {Int J Surg},
pages = {146--152},
title = {Ten-year improved survival in patients with multi-vessel coronary disease and poor left ventricular function following surgery: A retrospective cohort study.},
url = {http://dx.doi.org/10.1016/j.ijsu.2020.03.008},
volume = {76},
year = {2020}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - OBJECTIVE: Patients with multi-vessel coronary artery disease and poor left ventricular (LV) function (ejection fraction [EF] < 30%) requiring revascularization are considered 'high-risk'. Limited long-term survival data exists comparing percutaneous coronary intervention (PCI) with second-generation drug-eluting stents (DES) versus surgery for this cohort of patients. METHODS: We retrospectively reviewed our data for 321 patients with EF < 30% who underwent multi-vessel revascularization from January 2005 to December 2015 using Cox regression analyses and inverse probability treatment weighted (IPTW) methods. We stratified patients that underwent surgical revascularization into on-pump coronary artery bypass grafting (CABG) and off-pump CABG and analyzed all-cause mortality at 10 years compared to PCI. RESULTS: 214 patients underwent CABG (n [on-pump CABG] = 94; n [off-pump CABG] = 120) and 107 patients had PCI with second generation DES. PCI with DES had higher 10-year mortality compared with on-pump CABG (Hazard ratio [HR] = 1.86, 95% confidence interval [CI] = 1.46-2.42; p < 0.001) and off-pump CABG (HR = 2.32, 95% CI = 1.75-3.15; p < 0.001). This was confirmed in IPTW analyses. When adjusting for both measured and unmeasured factors using instrumental variable analyses, PCI with DES had higher 10-year mortality compared with on-pump CABG (Δ = 13.5, 95% CI = 3.2-24.5; p = 0.012) and off-pump CABG (Δ = 16.1, 95% CI = 5.9-25.8; p < 0.001). CONCLUSION: Surgical revascularization, preferably off-pump CABG, results in better long-term survival compared with PCI using second generation DES for patients with multi-vessel coronary artery disease and poor left ventricular function. Randomized controlled trials in this patient group should be undertaken.
AU  - Cummings,IG
AU  - Lucchese,G
AU  - Garg,S
AU  - Soni,M
AU  - Majid,AF
AU  - Marczin,N
AU  - Panoulas,V
AU  - Raja,SG
DO  - 10.1016/j.ijsu.2020.03.008
EP  - 152
PY  - 2020///
SP  - 146
TI  - Ten-year improved survival in patients with multi-vessel coronary disease and poor left ventricular function following surgery: A retrospective cohort study.
T2  - Int J Surg
UR  - http://dx.doi.org/10.1016/j.ijsu.2020.03.008
UR  - https://www.ncbi.nlm.nih.gov/pubmed/32173612
VL  - 76
ER  -
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