Three-vessel Coronary Artery Disease Research Articles

Abstract 14637: Effects of Dietary Patterns in the Severity of Coronary Artery Disease

Introduction: The impact of diet on atherosclerosis progression is well established. However, the independent predictive value of unhealthy diet in the prognosis and severity of coronary artery disease (CAD) has not been definitely confirmed and clinicians often ignore how to incorporate it in clinical practice. Hypothesis: Dietary patterns may impact CAD severity. Methods: In this cohort study we included 188 consecutive symptomatic stable CAD patients. The diagnosis of CAD was based on coronary angiography and patients were categorized as having severe CAD and non-severe CAD. The diagnosis of severe CAD was based on the presence of either left main coronary artery disease (stenosis≥50%), or three-vessel coronary artery disease, or two-vessel coronary artery disease marked by stenosis of the proximal left anterior descending artery ≥70%. Among several demographics and clinical characteristics all subjects were tested with a validated semi quantitative food frequency questionnaire. Results: Concerning baseline demographic characteristics there was no difference between subjects with severe CAD and non-severe CAD while, the prevalence of severe CAD was higher in current smokers compared to non-smokers. Principal component analysis revealed 8 distinct dietary patterns. The first component-western dietary pattern (increased intake of fat, red meat and carbohydrates and minimal consumption of fruits vegetables and green leafy)- was predictive of severe CAD (AUC:0.73, 95% CIs:0.64-0.83, p<0.001) and more interestingly, can increase the discriminative ability of a multivariate model based on all major risk factors. Conclusion: The unhealthy western type of diet is associated with the severity and extent of coronary artery lesions in patients with stable CAD. These findings highlight the importance of accessing dietary patterns when calculating cardiovascular risk and to take into consideration dietary habits in the management of cardiovascular patients.

Cost-effectiveness of percutaneous coronary intervention versus bypass surgery from a Dutch perspective

AimsRecent cost-effectiveness analyses of percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) have been limited by a short time horizon or were restricted to the US healthcare perspective....

Cardiac applications of PET

Routine use of cardiac positron emission tomography (PET) applications has been increasing but has not replaced cardiac single-photon emission computerized tomography (SPECT) studies yet. The majority of cardiac PET tracers, with the exception of fluorine-18 fluorodeoxyglucose (18F-FDG), are not widely available, as they require either an onsite cyclotron or a costly generator for their production. 18F-FDG PET imaging has high sensitivity for the detection of hibernating/viable myocardium and has replaced Tl-201 SPECT imaging in centers equipped with a PET/CT camera. PET myocardial perfusion imaging with various tracers such as Rb-82, N-13 ammonia, and O-15 H2O has higher sensitivity and specificity than myocardial perfusion SPECT for the detection of coronary artery disease (CAD). In particular, quantitative PET measurements of myocardial perfusion help identify subclinical coronary stenosis, better define the extent and severity of CAD, and detect ischemia when there is balanced reduction in myocardial perfusion due to three-vessel or main stem CAD. Fusion images of PET perfusion and CT coronary artery calcium scoring or CT coronary angiography provide additional complementary information and improve the detection of CAD. PET studies with novel 18F-labeled perfusion tracers such as 18F-flurpiridaz and 18F-FBnTP have yielded high sensitivity and specificity in the diagnosis of CAD. These tracers are still being tested in humans, and, if approved for clinical use, they will be commercially and widely available. In addition to viability studies, 18F-FDG PET can also be utilized to detect inflammation/infection in various conditions such as endocarditis, sarcoidosis, and atherosclerosis. Some recent series have obtained encouraging results for the detection of endocarditis in patients with intracardiac devices and prosthetic valves. PET tracers for cardiac neuronal imaging, such as C-11 HED, help assess the severity of heart failure and post-transplant cardiac reinnervation, and understand the pathogenesis of arrhytmias. The other uncommon applications of cardiac PET include NaF imaging to identify calcium deposition in atherosclerotic plaques and β-amyloid imaging to diagnose cardiac amyloid involvement. 18F-FDG imaging with a novel PET/MR camera has been reported to be very sensitive and specific for the differentiation between malignant and nonmalignant cardiac masses. The other potential applications of PET/MR are cardiac infectious/inflammatory conditions such as endocarditis.

Questions and answers on coronary revascularization: a companion document of the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation.

Q1: A patient with rise and fall of cardiac troponin, T-wave inversion in the lateral leads and mild hypokinesia in the lateral wall on echocardiography undergoes coronary angiography that reveals three-vessel coronary artery disease (CAD), with subocclusion of the left circumflex coronary artery (

Predictive Ability of the SYNergy Between Percutaneous Coronary Intervention with TAXus and Cardiac Surgery Score II for Long-term Mortality in Patients with Three-vessel Coronary Artery Disease Undergoing Percutaneous Coronary Intervention Treated with Second-generation Drug-eluting Stents.

Background:The SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery Score II (SS-II) can well predict 4-year mortality in patients with complex coronary artery disease (CAD), and guide decision-making between coronary artery bypass graft surgery and percutaneous coronary intervention (PCI). However, there is lack of data regarding the utility of the SS-II in patients with three-vessel CAD undergoing PCI treated with second-generation drug-eluting stents (DES). The purpose of the present study was to evaluate the ability of the SS-II to predict long-term mortality in patients with three-vessel CAD undergoing PCI with second-generation DES.Methods:Totally, 573 consecutive patients with de novo three-vessel CAD who underwent PCI with second-generation DES were retrospectively studied. According to the tertiles of the SS-II, the patients were divided into three groups: The lowest SS-II tertile (SS-II ≤20), intermediate SS-II tertile (SS-II of 21–31), and the highest SS-II tertile (SS-II ≥32). The survival curves of the different groups were estimated by the Kaplan–Meier method. Univariate and multivariate Cox proportional hazard regression analyses were performed to evaluate the relationship between the SS-II and 5-year mortality. The performance of the SS-II with respect to predicting the rate of mortality was studied by calculating the area under the receiver operator characteristic (ROC) curve. The predictive ability of the SS-II for 5-year mortality was evaluated and compared with the SS alone.Results:The overall SS-II was 27.6 ± 9.0. Among patients in the lowest, intermediate and the highest SS-II tertiles, the 5-year rates of mortality were 1.6%, 3.2%, and 8.6%, respectively (P = 0.003); the cardiac mortality rates were 0.5%, 1.9%, and 5.2%, respectively (P = 0.014). By multivariable analysis, adjusting for the potential confounders, the SS-II was an independent predictor of 5-year mortality (hazard ratio: 2.45, 95% confidence interval: 1.38–4.36; P = 0.002). The SS-II demonstrated a higher predictive accuracy for 5-year mortality compared with the SS alone (the area under the ROC curve was 0.705 and 0.598, respectively).Conclusion:The SS-II is an independent predictor of 5-year mortality in patients with three-vessel CAD undergoing PCI treated with second-generation DES, and demonstrates a superior predictive ability over the SS alone.

Clinical Outcomes After Drug-Eluting Stents Versus Coronary Artery Bypass Surgery in High Surgical Risk Patients With Left Main or Three-Vessel Coronary Artery Disease

Clinical Outcomes After Drug-Eluting Stents Versus Coronary Artery Bypass Surgery in High Surgical Risk Patients With Left Main or Three-Vessel Coronary Artery Disease

Heart beats: not to be beaten.

Heart beats: not to be beaten.

Zero coronary calcium in the presence of three-vessel and left main coronary artery disease in a Hodgkin lymphoma survivor.

We describe a 45-year-old male survivor of Hodgkin lymphoma, treated with mediastinal radiation therapy, referred for single-photon emission computed tomography (SPECT) myocardial perfusion imaging in combination with coronary artery calcium (CAC) scoring. SPECT demonstrated a reversible moderate-sized lateral perfusion defect, and the CAC score was zero. A calcium score of zero markedly reduces the probability of having coronary artery disease (CAD) and is associated with a very low risk of future cardiovascular events. However, a CAC score of zero does not completely rule out obstructive CAD. In this case, invasive coronary angiography revealed three-vessel CAD with left main involvement. Whether mediastinal radiation therapy in general is associated with CAD without accompanying CAC is yet unclear.

CABG, stents, or hybrid procedures for left main disease?

Coronary artery bypass graft (CABG) surgery, including grafting of the left internal mammary artery (LIMA) to the left anterior descending artery (LAD) with additional vein or IMA grafts to other vessels, remains the standard technique for treatment of three-vessel coronary artery disease in patients with an intermediate or high SYNTAX score. Unprotected left main coronary disease is most often found in association with multivessel disease. In these patients, CABG has long been considered the gold standard for revascularisation. However, the evidence is being challenged by technological and procedural advances in percutaneous coronary intervention. Especially in patients with low to intermediate anatomic complexity of left main disease, PCI can be an effective and durable treatment option. Left main bifurcation lesions, however, remain a challenging subset for PCI due to possible plaque shift and occlusion of a major side branch. While there is general agreement that coronary bypass revascularisation using the LIMA to the LAD provides the best long-term prognostic benefit, a combination of CABG to the LAD and PCI of the remaining lesions, a hybrid approach, takes advantage of the survival benefit of the LIMA to LAD bypass, while minimising invasiveness and lowering morbidity by avoiding median sternotomy, rib retraction, aortic manipulation, and cardiopulmonary bypass. In particular, elderly patients with severe concomitant diseases may benefit from this approach by avoiding CPB.

The possibility of reducing the Lp-PLA2 mass level using simvastatin monotherapy and combination therapy with ezetimibe

AimTo assess the impact of combined treatment with simvastatin and ezetimibe or treatment with simvastatin only on lipoprotein-associated phospholipase A2 mass level in patients with coronary heart disease. MethodsOne hundred patients with angiographically documented coronary atherosclerosis took part in the investigation. Lp-PLA2 mass level and cholesterol fractions were determined at baseline and after 6 months of treatment. Lp-PLA2 mass was determined by PLAC Test; DiaDexus, Inc. ResultsCombined treatment with ezetimibe and simvastatin led to significantly greater declines in Lp-PLA2 and lipid profile compared with treatment only with simvastatin (P<0.05). Combination therapy with ezetimibe and simvastatin 20mg/day proved to be as effective as monotherapy with simvastatin 80mg/day on the effect on Lp-PLA2 mass level and lipids (P<0.05). Lp-PLA2 mass level was initially higher in patients with three-vessel coronary artery disease, compared with patients with one-vessel coronary artery disease while baseline levels of lipids and hs-CRP did not differ significantly. ConclusionsCombined treatment, using half the dose of simvastatin, led to greater reduction of Lp-PLA2 mass level total cholesterol and LDL-C, compared to monotherapy with simvastatin. Due to the steady decline of target levels of LDL-C, which leads to prescribing high doses of statins (and it is not always possible because of the presence of co-morbidities), combination therapy with statin and ezetimibe is a reliable alternative, which allows not only to largely reduce LDL-C but also to significantly reduce such important participants of atherosclerosis process and markers of inflammation, as Lp-PLA2 and CRP.

Predictors of renal artery stenosis in patients undergoing cardiac catheterization for suspected coronary artery disease

AimThis study determined the prevalence of Renal Artery Stenosis (RAS) and established its predictors in patients undergoing cardiac catheterization for suspected Coronary Artery Disease (CAD). Methods1266 patients underwent coronary angiogram for suspected CAD. Following coronary angiogram, bilateral selective renal angiogram was performed. Study population was split into cohorts with and without RAS. A binary logistic regression model was used to identify univariate predictors of RAS. Significant univariate predictors were used to build a multivariate logistic regression model. Comparative accuracy of various models in predicting RAS was estimated by computing areas under the Receiver Operating Characteristic (ROC) curve. ResultsPrevalence of significant RAS in study population was 6.0%. In univariate analysis, mean age (p = 0.002), diabetes mellitus (p = 0.009), hypertension of more than five years duration (p = 0.034), serum creatinine concentration of >1 mg per 100 ml (p = 0.009), peripheral arterial disease (p = 0.019), and significant CAD (p = 0.037) were predictors of RAS. In the multivariate analysis, serum creatinine concentration (p = 0.002), peripheral arterial disease (p = 0.017), Two-vessel CAD (p = 0.043), and Three-vessel CAD (p = 0.007) were independent predictors of RAS. Areas under the non-crossing ROC curves revealed that a simple model incorporating two-vessel CAD and three-vessel CAD had an acceptable accuracy in predicting RAS. ConclusionIt may not be appropriate to extrapolate the findings of research conducted in other demographic settings to Indian patients. “Drive by” renal angiogram in Indian settings may be done only in patients with multi-vessel CAD presenting with indisputable clinical indications. However, in the long run, we should be open to new research.

Pulmonary valve papillary fibroelastoma: a rare tumor and rare location.

Although rare, papillary fibroelastomas (PFEs) are considered the third most common cause of primary cardiac neoplasm. They are usually asymptomatic and are found during routine echocardiography. PFEs of the pulmonary valve are extremely rare. They are usually benign; however, because of their potential to embolize to the pulmonary circulation, it is often recommended that they be removed. This article reviews a case of an asymptomatic PFE of the pulmonary valve, incidentally found in a patient who presented with three-vessel coronary artery disease.

Is the diagnostic yield of myocardial stress perfusion MRI impaired by three-vessel coronary artery disease?

Three-vessel coronary artery disease (CAD) comes along with globally reduced myocardial perfusion potentially restricting the demarcation of regional hypoperfusion in stress perfusion cardiac magnetic resonance imaging (MRI). To evaluate whether stress perfusion cardiac MRI is capable of detecting myocardial hypoperfusion in patients with 3-vessel CAD reliably. Two hundred and five patients with symptoms of CAD were included. The examination protocol comprised imaging of myocardial perfusion at stress (0.14 mg/kg/min adenosine for 4 min) using a 2D saturation recovery gradient echo sequence after administration of gadobutrol (0.1 mmol/kg body weight). Perfusion sequences were assessed qualitatively by two experienced observers. Coronary angiography served as standard of reference. Sensitivity and specificity for hemodynamically relevant stenoses in patients with 0-, 1-, 2-, 3-vessel coronary artery disease were 100%/91%, 91%/73%, 90%/71%, 92%/64%; positive/negative predictive value, 67%/100%, 91%/73%, 83%/81%, 93%/58%; diagnostic accuracy, 93%/87%/83%/87%, respectively. The negative predictive value in patients with 3-vessel CAD was lower than in patients with 0- and 2-vessel CAD and the specificity lower than in patients with no CAD whereas the positive predictive value was higher than in patients with no CAD. The other proportions did not differ significantly between the groups. The diagnostic value of stress perfusion cardiac MRI in patients with 3-vessel CAD is comparable to results in patients with 1- or 2-vessel CAD. In the rare event that stress perfusion images do not depict regional hypoperfusion in patients with severe 3-vessel CAD, myocardial ischemia could be identified by reduced semi-quantitative perfusion parameters.

Identification of a definite diabetic cardiomyopathy in type 2 diabetes by comprehensive echocardiographic evaluation: A cross‐sectional comparison with non‐diabetic weight‐matched controls

Subclinical left ventricular (LV) dysfunction is prevalent in type 2 diabetes (T2DM). As obesity has been proposed as one causal factor in the disease process, this could bias the reported prevalences. We wanted to characterize echocardiographic LV dysfunction in obese T2DM subjects as compared to non-diabetic obese controls. One hundred patients with T2DM without clinical signs of heart failure (29% females, mean ± SD age 58.4 ± 10.5 years, body mass index (BMI) 30.1 ± 5.5 kg/m(2), blood pressure (BP) 141 ± 18/83 ± 9 mmHg) and 100 non-diabetic controls (29% females) matched for age (58.6 ± 10.5 years), BMI (29.8 ± 4.0 kg/m(2) and systolic BP (140 ± 14 mmHg) underwent echocardiography and color tissue Doppler imaging (TDI). Diastolic function was evaluated with conventional Doppler recordings and early (e') and late (a') myocardial velocities. The ratio between early transmitral filling (E) and the corresponding myocardial tissue velocity (e') served as an index of LV filling pressure. T2DM patients had more concentric hypertrophy with a relative wall thickness of 0.42 ± 0.07 vs controls 0.38 ± 0.07, P < 0.001. The T2DM group had signs of diastolic dysfunction with lower E/A ratio (0.91 ± 0.27 vs. 1.12 ± 0.38, P < 0.001), deceleration time (195 ± 49 vs 242 ± 72 ms, P < 0.001), e' (5.7 ± 2.0 vs. 6.6 ± 1.8 cm/s, P = 0.001), and a' (6.5 ± 2.0 vs. 7.6 ± 1.5 cm/s, P < 0.001) compared to the controls, and higher E/e' (13.3 ± 4.7 vs. 11.1 ± 3.5, P < 0.001). Thus, there were indications of pseudo normalization and increased filling pressure in the T2DM group, whereas the controls had evidence for relaxation abnormalities without elevated filling pressure. Compared to a non-diabetic obese group, more advanced subclinical impairment of diastolic function was seen in T2DM.

Kinetics of plasma microRNA-499 expression in acute myocardial infarction.

MicroRNA (miRNA) is reported to be present in human plasma and has been increasingly suggested as a biomarker for diseases. Our study aimed to investigate the kinetics of cardiac-specific microR-499 (miR-499) in acute myocardial infarction (AMI). Circulating concentrations of cardiac enriched miR-499 were measured by quantitative PCR in 73 patients with acute coronary syndrome (ACS), including 53 with AMI and 20 with unstable angina (UA). Thirty healthy subjects were used as controls. Plasma samples in AMI group were obtained immediately after admission and at 12 h, 24 h, 3 d and 7 d after onset of symptoms. Plasma samples in UA and healthy control groups were collected immediately after admission. The severity and extent of coronary stenotic lesions were evaluated on the basis of coronary angiography using Gensini score. miR-499 expression levels were significantly higher in the 53 AMI patients than in the 20 UA patients and 30 healthy controls immediately after admission (P<0.01). A measurable increase in miR-499 levels was observed in AMI patients within 24 h of the last onset of chest pain and the levels returned to the baseline after 7 d. Plasma miR-499 levels in the patients with AMI were positively-correlated with cTnI (r=0.384, P<0.01) and CK-MB (r=0.402, P<0.01). In addition, miR-499 levels in AMI patients with two- and three-vessel coronary artery disease (CAD) were significantly higher than those in patients with single-vessel CAD (P<0.05). Gensini scores were used to evaluate the severity of coronary stenosis. miR-499 were positively correlated with Gensini scores (r=0.52, P<0.01). miR-499 levels at admission were significantly higher than that those 24 h after percutaneous coronary intervention (PCI) in AMI patients (P<0.01) and were negatively correlated with LVEF (r=0.36, P=0.008). Cardiac-specific miRNA-499 levels were found to be linearly proportional to myocardial damage. MiRNA-499 might prove to be a new biomarker for AMI and a predictor of the risk of myocardial ischemia.

Novel application of mesenchymal stem cells from mammary artery

The incidence of 1 to 4% of mediastinitis has been reported to occuras a consequence of cardio-thoracic surgery procedures. This complica-tioncontinuestohaveadramaticimpactonpatientoutcomesreportinghospital mortality between 10 and 20% [1]. Recently, vacuum therapyand new techniques as wound dressing with plasma rich of plateletsand wound reconstruction with autologous or heterologous tissue [2]have improved clinical results; nevertheless morbidity remains consis-tent and mortality still occurs in patients withco-morbiditiesfollowingprolonged hospital stay. Thus, not-conventional approaches have beenproposed to get better results in regenerative medicine applied to sec-ondary mediastinitis.Here we report on recurrent sternotomyinfectionrefractory to con-ventionaltreatments,successfullyapproachedwithanoriginalprotocolbased on the use of autologous MSC derived from fragments of leftinternal mammary artery (LIMA) not utilized during the first CABG op-eration. A 83 year old, man, suffering from type 2 diabetes mellitustreated with insulin therapy, hypochromic anemia, hypertension, pe-ripheral artery occlusive disease, three-vessel coronary artery disease,underwent on pump CABGx3 through median sternotomy. LIMA washarvestedandimplantedontheleftanteriordescendingartery.Sequen-tial venous graft was performed on posterior descending and obtusemarginal braches. Excess of the length of mammary artery was sent tothe Human Cellular Biology Laboratory IRC-FSH

Elevated Serum Tryptase and Endothelin in Patients with ST Segment Elevation Myocardial Infarction: Preliminary Report.

An inflammatory response plays a crucial role in myocardial damage after an acute myocardial infarction. Objectives. To measure serum concentrations of several mediators in patients with an acute myocardial infarction (STEMI) and to assess their potential relationship with a risk of coronary instability. Patients and Methods. The 33 patients with STEMI and 19 healthy volunteers were analyzed. The clinical data were obtained; as well serum concentrations of tryptase, endothelin (ET-1), angiogenin, soluble c-kit, and PDGF were measured. Results. Patients with STEMI had higher serum tryptase and ET-1 than healthy volunteers (2,5 ± 0,4 ng/mL versus 1,1 ± 0,4 ng/mL and 0,7 ± 0,1 ng/mL versus 0,3 ± 0,1 ng/mL, resp.). Subjects with significant lesion in left anterior descending artery (LAD) had lower serum ET-1 compared to those with normal LAD (0,6 ± 0,2 pg/mL versus 0,9 ± 0,4 pg/mL). Patients with three-vessel coronary artery disease (CAD) had higher level of soluble c-kit compared to those with one- or two-vessel CAD: 19,9 ± 24,1 ng/mL versus 5,6 ± 1,9 ng/mL. Conclusions. Elevated serum tryptase and ET-1 may be markers of increased coronary instability; some cytokines may be related to the extension of CAD.

A case of three-vessel coronary artery disease with coronary artery-pulmonary artery fistula and the right coronary artery high left origin that developed prehospital cardiac arrest

A case of three-vessel coronary artery disease with coronary artery-pulmonary artery fistula and the right coronary artery high left origin that developed prehospital cardiac arrest

Acute Coronary Syndrome: An Unusual Consequence of GERD.

We report a case of an 83-year-old man with history of coronary artery disease and gastroesophageal reflux disease (GERD) who presented with sudden onset nocturnal dyspnea. He was diagnosed with non-ST elevation myocardial infarction based on the electrocardiographic changes and cardiac biomarker elevation. Cardiac catheterization revealed chronic three-vessel coronary artery disease, with 2 patent grafts and 2 chronically occluded grafts. While at the hospital, the patient experienced a similar episode of nocturnal dyspnea, prompting a barium esophagram, which was suggestive of a stricture in the distal esophagus from long-standing GERD. We hypothesized that he had myocardial ischemia due to increased oxygen demand from uncontrolled GERD symptoms. He had no further ischemic episodes after increasing the dose of antireflux medication over a 6-month follow-up. After presenting our case, we review the literature on this atypical presentation of GERD causing acute coronary syndrome and discuss potential mechanisms.

Abstract 18210: Impact of AHA/ACC Coronary Artery Bypass Grafting and Percutaneous Coronary Intervention Guidelines on Real-world Treatment Strategies for Complex Coronary Artery Disease

Introduction: 2011 ACCF/AHA coronary artery bypass grafting (CABG) guideline and percutaneous coronary intervention (PCI) guideline were published on December 2011.The aim of this study is to explore the impact of guidelines’ publication on real-world treatment for three-vessel or left-main coronary artery disease (CAD). Hypothesis: The release of revascularization guidelines has a positive impact on real-world practice and 1-year outcomes of patients with complex CAD. Methods: Between July 2011 and September 2012, patients diagnosed as three-vessel or left-main CAD at Fuwai hospital were consecutively enrolled. We reviewed medical records to abstract detailed in-hospital information. The Corelab calculated SYNTAX Scores according to coronary angiograms. We conducted follow-up at 12 months after the index hospitalization. The end point was major adverse cerebral and cardic event (MACCE) including death, myocardial infarction, stroke and additional revascularization. Patients were then divided into pre-guideline group and post-guideline group according to the conary angiography date. Binary viariables logistic model and Cox model were uesd for baseline and 1-year outcomes comparison respectively Results: 1746 patients were consecutively enrolled. 37.9% (662) were in pre-guideline group, 62.1% (1084) in post-guideline group. There were no significant differences in demographic factors, cardiac surgery risks and SYNTAX Scores between pre- and post-guideline groups. After the publication of 2011 ACCF/AHA guidelines, doctors recommended more patients to choose CABG (pre: 49.0%, post: 55.6%, p&lt;0.05), the surgeons’ consultation rate increased (pre: 41.9%, post: 49.9%, p&lt;0.05), the rate of ad hoc PCI (PCI immediately after coronary angiography) decreased (pre: 47.5%, post: 40.9%, p&lt;0.05). After adjustment for coronary anatomy complexity and cardiac surgery risks using Cox model, pre-guideline group was associated with significantly higher rates of MACCE (HR=1.62, 95% confidential interval: 1.15-2.27). Conclusions: The publication of 2011 ACCF/AHA CABG and PCI guidelines significantly changed real-world treatment for complex CAD in Fuwai hospital, and further improved outcomes.