Revascularization Versus Medical Therapy in Takayasu's Arteritis Patients with Coronary Artery Involvement
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ORIGINAL RESEARCH
Revascularization Versus Medical Therapy in Takayasu’s Arteritis Patients with Coronary Artery Involvement Zhiwei Huang . Hongliang Zhang . Man Wang . Weixian Yang . Shubin Qiao . Fenghuan Hu
Received: September 27, 2020 / Accepted: October 30, 2020 Ó The Author(s) 2020
ABSTRACT Introduction: Treatment strategies to improve clinical outcomes in Takayasu’s arteritis (TA) with coronary lesions have ranged from pharmacological therapy to invasive procedures, such as coronary angioplasty, stenting, and surgery. However, the therapeutic strategy for this kind of patient is still unclear. This study aimed to investigate the clinical characteristics and influence of revascularization versus medical therapy in TA patients with coronary artery involvement. Methods: We analyzed the medical records of 806 TA patients between January 2008 and December 2019. Clinical features and treatment were analyzed, and patients were categorized into medical treatment and revascularization. Additionally, patients were sorted as percutaneous coronary intervention (PCI) and coronary artery bypass surgery (CABG) based on the strategy of revascularization.
Z. Huang H. Zhang M. Wang W. Yang S. Qiao (&) F. Hu (&) Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China e-mail: [email protected]. Hu e-mail: [email protected]
Results: Ninety cases with coronary lesions induced by TA were enrolled. Among 90 cases, 39 patients adopted conservative treatment, and 51 patients received revascularization (28 subjects with PCI, 23 participants with CABG). The median follow-up time was 63 (45–91) months. There is no significant difference in cardiovascular death between medical treatment and revascularization (2/39, 5.1% vs. 5/51, 9.8%, P = 0.971). The analysis of subgroup indicated that the mortality caused by cardiovascular disease was also similar in the CABG and PCI (2/28, 7.1% vs. 3/23, 13.0%, P = 0.772). However, the proportion of restenosis is much higher in the PCI compared with that of CABG (39.3%, 8.7%, P = 0.022, respectively). Heart failure is an independent predictor of death in these patients. Conclusions: There is no significant difference in cardiovascular death between medical treatment and revascularization. The analysis of the subgroup indicated that the mortality caused by cardiovascular disease was also similar in the CABG and PCI, but the restenosis is much higher in the PCI compared with that of CABG. Heart failure is an independent predictor of death in these patients. Keywords: Coronary artery bypass surgery; Coronary artery involvement; Medical treatment; Percutaneous coronary intervention; Takayasu’s arteritis
Rheumatol Ther
INTRODUCTION Key Summary Points Why carry out this study? Coronary artery involvement significantly increases mortality of patients with Takayasu’s arteritis (TA), however, the optimal therapeutic strategy for this condition has not been well established. What was learned from
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