title: Characteristics, management and five-year outcomes of patients with high risk, stable multivessel coronary heart disease.
abstract: BACKGROUND
  Multivessel coronary artery disease (MCAD) is a common manifestation of advanced coronary atherosclerosis.
  
  
  OBJECTIVE
  To determine the clinical characteristics and long term follow up prognostic factors in patients with high risk, stable MCAD from a single institution.
  
  
  METHODS
  We included in the final analysis 270 patients with stable MCAD. Patients were followed for the occurrence of death, stroke and myocardial infarction (MI). We defined a cumulative major adverse cardiac and cerebrovascular event (MACCE) asa composite of death, stroke, MI and urgent revascularisation. Median follow up was 5 years (4-5.5 years). 176 (65%) patients were treated surgically (coronary artery bypass grafting, CABG), 19 (7%) patients were treated percutaneously, while 75 (28%) patients were treated medically; this meant that 94 (35%) patients were treated non-surgically.
  
  
  RESULTS
  Predictors of MACCE in the study group of patients revealed by univariate logistic regression analysis were: diabetes mellitus (p = 0.04), kidney failure (p = 0.05), total cholesterol (p = 0.05), LDL-cholesterol (p = 0.02), chest pain symptoms in CCS III class (p = 0.05), heart rate (p = 0,02), NT-proBNP (p = 0.01), left ventricular diastolic (p = 0.003) and systolic diameter (p = 0.003), left ventricular ejection fraction (p = 0.001), Gensini score (p = 0.05) and CABG treatment strategy (p = 0.001). In Cox logistic regression analysis, non CABG treatment strategy (b = 0.06), heart rate (b = 0.02), and LDL cholesterol level (b = 0.006) were independent predictors of MACCE (p = 0.01).
  
  
  CONCLUSIONS
  Our study showed that patients with advanced MCAD who are qualified for complete surgical revascularisation benefitted more with regard to several primary end points at five-year follow-up than those who were not qualified for surgery and who were treated with medical therapy supplemented in selected cases with incomplete percutaneous revascularisation.
authors.affiliation: Department of Cardiology, Medical University of Lodz, Lodz, Poland. rkrecki@gazeta.pl.
authors.forename: Radosław
authors.initials: R
authors.lastname: Kręcki
authors.forename: Agata
authors.initials: A
authors.lastname: Arazińska
authors.forename: Jan Zbigniew
authors.initials: JZ
authors.lastname: Peruga
authors.forename: Michał
authors.initials: M
authors.lastname: Plewka
authors.forename: Jarosław Damian
authors.initials: JD
authors.lastname: Kasprzak
authors.forename: Maria
authors.initials: M
authors.lastname: Krzemińska-Pakuła
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D012307:Risk Factors; D016896:Treatment Outcome