Long-Term Outcomes of Coronary and Carotid Artery Disease Revascularization in the FRIENDS Study.

Fabrizio Tomai,Roberto Nerla,Raoul Borioni,Fausto Castriota,Giovanni De Persio,Anna Piccoli,Gabriele Pesarini,Alberto Cremonesi,Flavio Ribichini,Bernhard Reimers,Andrea Pacchioni,Luca Weltert

doi:10.1155/2019/8586927

Abstract

Objectives The aim of this study is to assess long-term-outcomes of patients with concomitant CAD and COD treated with different revascularization strategies. Background Multisite artery disease is common and patients with combined disease have poor prognosis. The best therapeutic strategy for patients with concomitant carotid obstructive disease (COD) and coronary artery disease (CAD) remains controversial. Methods This observational registry enrolled, between January 2006 and December 2012, 1022 consecutive patients from high volume institutions with concomitant CAD and COD suitable for endovascular, surgical, or hybrid revascularization in both territories selected by consensus of a multidisciplinary team. Results The cumulative incidence of 5-year major cardiovascular events (MACCE) including cardiovascular death, myocardial infarction (MI), or stroke in the overall population was 12%. The incidence of 5-year MACCE was not statistically different in the surgical, endovascular, or hybrid patients group (10.1% vs. 13.0% vs. 13.2%, P = .257, respectively). However, the hybrid group exhibited rates of myocardial infarction, chronic kidney disease, and cumulative incidence of all clinical events higher than the surgical group. After propensity score matching, the incidence of 5-year MACCE was similar in the three groups (13.0% vs. 15.0% vs. 16.0%, p = .947, respectively). Conclusions An individualized revascularization approach of patients with combined CAD and COD yields very good results at long-term follow-up, despite the high risk of this multilevel population even when the baseline clinical features are equalized.

Highlights

Multisite artery disease (MSAD) is defined by the simultaneous presence of clinically relevant atherosclerotic lesions in at least two major vascular territories [1]
Patients with coexisting coronary artery disease (CAD) and carotid obstructive disease (COD) represent a complex and high-risk population, in whom revascularization can be performed by surgical, endovascular, or hybrid strategies
The absence of dedicated randomised trials or large registries designed to assess advantages, shortcomings, and longterm-outcomes of patients with concomitant CAD and COD treated with different revascularization strategies add further uncertainty on the management of this rapidly growing subset of high-risk patients [6]

Summary

Introduction

Multisite artery disease (MSAD) is defined by the simultaneous presence of clinically relevant atherosclerotic lesions in at least two major vascular territories [1]. In general the treatment strategy is decided case by case within the context of a dedicated multidisciplinary team and most experts agree on focusing first on the symptomatic vascular territory. Patients with coexisting coronary artery disease (CAD) and carotid obstructive disease (COD) represent a complex and high-risk population, in whom revascularization can be performed by surgical, endovascular, or hybrid strategies (the latest being a combined approach that includes both forms of treatment). The absence of dedicated randomised trials or large registries designed to assess advantages, shortcomings, and longterm-outcomes of patients with concomitant CAD and COD treated with different revascularization strategies add further uncertainty on the management of this rapidly growing subset of high-risk patients [6]

Objectives

Methods

Results

Conclusion