Comparison of complications associated with conservative and surgical treatment for stable cases of coronary artery disease: meta-analysis and systematic review
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20233864Keywords:
Surgical treatment, Conservational treatment, Post-treatment complications, Stable CAD, CAD, ComplicationsAbstract
Coronary artery disease (CAD) is a severe public health issue. Genetic, environmental, and lifestyle factors affect the development of coronary artery disease. There are several medicinal and interventional treatments offered to treat CAD. This study aimed to compare the complications associated with conservative and surgical treatments of CAD. Data was taken from PubMed, where 679 clinic trials and randomised control trials were chosen after adding filters and 25 studies were added by hand search. Articles were then analysed, and only ten studies were taken for meta-analysis. A total of 41025 patients were added to these studies, out of which 12077 were treated surgically and 28948 were treated by conservative management either by monotherapy or combined medicinal therapy. Further, the meta-analysis done with the help of Revman concluded that 6% (CI 0.00–16.8%) complication cases were reported in conservative treatment and 2% (CI 0.00–23%) in surgical treatment, where the I2 was 100%. Considering the treatments separately, 901 patients given monotherapy and 354 given combined medicinal therapy were reported to have complications. As per the surgical treatments, 509 cases were reported when treated by SAG, and MAG, 216 with PCI, and CABG, 40 when treated by EVH and OVH, and 10 patients faced complications when treated with angioplasty, reported to suffer complications after treatment. So, the surgical treatments, as per this review, have been proven to have less complications than conservative treatment.
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References
Poli FE, Gulsin GS, McCann GP, Burton Neumann FJ, Sousa-Uva M, Ohlsson A, et al. 2018 ESC/EACTS Guidelines on myocardial revascularisation. Eur Heart J. 2019;40:187-5.
Tsivgoulis G, Safouris A, Kim DE, Alexandrov AV. Recent Advances in Primary and Secondary Prevention of Atherosclerotic Stroke. J Stroke. 2018;20(2):145-66.
Knuuti J. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes The Task Force for the diagnosis and management of chronic coronary syndromes of the European Society of Cardiology (ESC). Russian J Cardiol. 2020;25(2):119-80.
Donner-Banzhoff N, Sönnichsen A. Statins and primary prevention of cardiovascular events. BMJ. 2008;337(2):2576.
Ferraro R, Latina JM, Alfaddagh A, Michos ED, Blaha MJ, Jones SR, et al. Evaluation and Management of Patients With Stable Angina: Beyond the Ischemia Paradigm: JACC State-of-the-Art Review. J Am Coll Cardiol. 2020;76(19):2252-66.
Liao GZ, Li YM, Bai L, Ye YY, Peng Y. Revascularization vs. conservative medical treatment in patients with chronic kidney disease and coronary artery disease: a meta-analysis. Front Cardiovasc Med. 2021;8:818958.
Ganyukov VI, Кочергин HA, Шилов AA, Tarasov RS, Skupień J, Szot W, et al. Randomised Clinical Trial of Surgical vs. Percutaneous vs. Hybrid Revascularization in Multivessel Coronary Artery Disease: Residual Myocardial Ischemia and Clinical Outcomes at One Year—Hybrid Coronary Revascularization Versus Stenting or Surgery (HREVS). J Intervent Cardiol. 2020;1-11.
Rittger H, Schnupp S, Sinha AM, Breithardt OA, Schmidt M, Zimmermann S, et al. Predictors of treatment in acute coronary syndromes in the elderly: impact on decision making and clinical outcome after interventional versus conservative treatment. Catheter Cardiovasc Interv. 2012;80(5):735-43.
Eikelboom JW, Bosch J, Connolly SJ, Shestakovska O, Dagenais GR, Hart RG, et al. Major bleeding in patients with coronary or peripheral artery disease treated with rivaroxaban plus aspirin. J Am Coll Cardiol. 2019;74(12):1519-28.
Chernyavskiy A, Volkov A, Lavrenyuk O, Terekhov I, Kareva Y. Comparative results of endoscopic and open methods of vein harvesting for coronary artery bypass grafting: a prospective randomized parallel-group trial. J Cardiothorac Surg. 2015;10:163.
Sondagur AR, Wang H, Cao Y, Lin S, Li X. Success rate and safety of coronary angiography and angioplasty via radial artery approach among a Chinese population. J Invasive Cardiol. 2014;26(6):273-5.
Naito R, Miyauchi K, Yasuda S, Kaikita K, Akao M, Ako J, et al. Rivaroxaban Monotherapy vs Combination Therapy With Antiplatelets on Total Thrombotic and Bleeding Events in Atrial Fibrillation With Stable Coronary Artery Disease: A Post Hoc Secondary Analysis of the AFIRE Trial. JAMA Cardiol. 2022;7(8):787-94.
Alam SR, Stirrat C, Spath N, Zamvar V, Pessotto R, Dweck MR, Moore C, Semple S, El-Medany A, Manoharan D, Mills NL, Shah A, Mirsadraee S, Newby DE, Henriksen PA. Myocardial inflammation, injury and infarction during on-pump coronary artery bypass graft surgery. J Cardiothorac Surg. 2017 Dec 16;12(1):115
Rezende PC, Hueb W, Garzillo CL, Lima EG, Hueb AC, Ramires JA, et al. Ten-year outcomes of patients randomized to surgery, angioplasty, or medical treatment for stable multivessel coronary disease: effect of age in the Medicine, Angioplasty, or Surgery Study II trial. J Thorac Cardiovasc Surg. 2013;146(5):1105-12.
Investigators CH. Rivaroxaban in Patients with Heart Failure, Sinus Rhythm, and Coronary Disease. N Engl J Med. 2018;379(14):1332-42.
Thuijs DJFM, Davierwala P, Milojevic M, Deo SV, Noack T, Kappetein AP, et al. Long-term survival after coronary bypass surgery with multiple versus single arterial grafts. Eur J Cardiothorac Surg. 2022;61(4):925-33.
Katritsis DG, Ioannidis JPA. Percutaneous coronary intervention versus conservative therapy in nonacute coronary artery disease. Circulation. 2005;111(22):2906-12.
Björklund L, Wallander M, Johansson S, Lesén E. Aspirin in cardiology - benefits and risks. Int J Clin Pract. 2009;63(3):468-77.