Effectiveness of Clinical, Surgical and Percutaneous Treatment to Prevent Cardiovascular Events in Patients Referred for Elective Coronary Angiography: An Observational Study

Figures & data

Figure 1 Study flowchart. PCI, percutaneous coronary intervention; CABG, coronary artery bypass grafting; CAD, coronary artery disease; MACCE, major adverse cardiac and cerebral events, as defined in Methods section.

Table 1 Baseline Clinical and Angiographic Characteristics

Baseline Characteristics^#	MT Alone (n=124)	PCI (n=251)	CABG (n=79)	Without CAD (n=360)	P value
Age (years)	61.9 ± 10.2^b	60.8 ± 9.4^ab	61.7 ± 8.4^b	58.1 ± 10.3^a	<0.001
Male	69 (55.6)	173 (68.9)*	54 (68.4)*	165 (45.8)**	<0.001
Race white	87 (70.2)	176 (70.1)	61 (77.2)	269 (74.7)	0.424
Years at school	5 (3–8)^ab	5 (4–9)^b	6 (4–10)^ab	5(3–8)^a	0.001
BMI (kg/m2)	28.9 ± 5.2^ab	28.1 ± 4.3^ab	27.4 ± 4.2^a	29.3 ± 5.6^b	0.002
SBP (mmHg)	141.9 ± 23.5^ab	141.1 ± 23.9^ab	144.8 ± 20.6^b	137.9 ± 21.1^a	0.036
DBP (mmHg)	79.7 ± 11.9	81.5 ± 12.9	83.2 ± 11.6	80.5 ± 11.6	0.154
Diabetes mellitus	42 (33.9)	71 (28.3)	31 (39.2)*	81 (22.5)**	0.006
Hypertension	114 (91.9)	236 (94)*	76 (96.2)*	293 (81.4)**	<0.001
Previous myocardial infarction	45 (36.3)**	127 (50.6)	51 (64.6)*	–	<0.001
LVEF (%)	62.6 ± 14.1^ab	63.2 ± 14.7^b	58.3 ± 15.9^a	67.5 ± 10.7^c	<0.001
HF	19 (15.3)	40 (15.9)	17 (21.5)*	27 (7.5)**	0.001
Glucose (mg/dL)	103.4 ± 33.1^a	106.5 ± 27.8^ab	114.7 ± 45.9^b	103.0 ± 27.4^a	0.016
Total Cholesterol (mg/dL)	170.4 ± 47.3	170.6 ± 45.3	176.6 ± 51.8	172.0 ± 40.0	0.734
HDL-C (mg/dL)	41.4 ± 11.1^ab	39.7 ± 9.9^a	40.7 ± 10.1^a	44.5 ± 11.4^b	<0.001
Triglycerides (mg/dL)	119.5 (87.0–173.8)	125 (90.0–169.0)	122 (91–176)	115 (81–158.0)	0.238
Creatinine (mg/dL)	0.69 ± 0.21	0.71 ± 0.21	0.72 ± 0.22	0.66 ± 0.24	0.105
hs-CRP (mg/dL)	2.5 (0.8–5.8)	2.8 (0.9–7.0)	2.1 (0.8–5.0)	2.2 (0.8–5.1)	0.127
Smoking	85 (68.5)	168 (66.9)*	44 (55.7)	207 (57.5)**	0.026
Current smoking	16 (12.9)	40 (15.9)	3 (3.8)**	51 (14.2)	0.050
Chest Pain	29 (23.4)	44 (17.5)**	15.0 (19)	139 (38.6)*	<0.001
Dyspnea	44 (35.5)	68 (27.1)**	26 (32.9)	167 (46.4)*	<0.001
10-year ASCVD risk	16.7 (8.2–24.2)^b	15.6 (9.1–23.4)^b	19.6 (11.2–28.1)^b	10.9 (5.8–11.7)^a	<0.001
SXscore^***	4.3 (0–11)^a	8(5–13)^b	21.5 (13–26.5)^c	-	<0.001
Low SXscore	117 (94.4)*	235 (93.6)*	49 (62)**	-	<0.001
Intermediate SXscore	5 (4)**	15 (6)**	21 (28.6)*	-
High SXscore	2 (1.6)	1 (0.4)**	9 (11.4)*	-
Indication of coronary angiography
Suggestive symptoms of CAD	100 (80.6)**	209 (83.3)**	72 (91.1)	338 (93.9)*	<0.001
With a positive noninvasive test	50 (40.3)	86 (34.3)**	38 (48.1)	160 (44.4)	0.043
Other complaints	11 (8.9)	16 (6.4)	8 (10.1)	32 (8.9)	0.616

Notes: *Statistically significant positive association by adjusted residuals test to 5% of significance. **Statistically significant negative association by adjusted residuals test to 5% of significance. ^a.b.cEqual letters do not differ by the Scheffé’s or Dunn’s Test at 5% significance. ^***Low SXscore < 23; Intermediate SXscore = 23–32; High SXscore > 32. ^#Variables were described by mean ± SD, median (P25-P75) or as number (percentage).

Abbreviations: ASCVD, atherosclerotic cardiovascular disease; BMI, body mass index; CABG, coronary artery bypass grafting; CAD, coronary artery disease; HDL-C, high-density lipoprotein cholesterol; hs-CRP, high-sensitivity C-reactive protein; DBP, diastolic blood pressure; HF, heart failure; LVFE, left ventricular fraction ejection; MT, medical-therapy; PCI, percutaneous coronary intervention; SBP, systolic blood pressure; SXscore, SYNTAX score.

Table 2 Major Clinical Outcomes According to the Treatment of the Patients

Type of Event^#	MT Alone (n=124)	PCI (n=251)	CABG (n=79)	Without CAD (n=360)	P value
All-cause death	24 (19.4)*	25 (10)	16 (20.3)*	41 (11.4)	0.012
Cardiovascular death	11 (8.9)	13 (5.2)	13 (16.5)*	29 (8.1)	0.016
Myocardial infarction	13 (10.5)	28 (11.2)*	15 (19)*	2 (0.6)**	<0.001
Stroke	4 (3.2)	7 (2.8)	6 (7.6)	16 (4.4)	0.268
Heart failure	19 (15.3)	40 (15.9)	17 (21.5)*	27 (7.5)**	0.001
Late Revascularization	18 (14.5)	66 (26.3)*	9 (11.4)	3 (0.8)**	<0.001
MACCE-1	24 (19.4)	39 (15.5)	24 (30.4)*	41 (11.4)**	<0.001
MACCE-2	30 (24.2)	82 (32.7)*	30 (38)*	42 (11.7)**	<0.001

Notes: *Statistically significant positive association by adjusted residuals test to 5% of significance. **Statistically significant negative association by adjusted residuals test to 5% of significance. ^#Variables were described as number (percentage).

Abbreviations: MACCE, major adverse cardiac and cerebral events; MACCE-1, composite of cardiovascular death, myocardial infarction and stroke; MACCE 2, all components of MACCE-1 plus late revascularization; MT, medical-therapy.

Figure 2 Event-free survival curves for all-cause death, cardiovascular death, MACCE-1, and MACCE-2 adjusted for age, sex, school degree, BMI, DM, hypertension, chest pain, HDL-C, creatinine, hs-CRP, smoking, HF, LVEF, MI before the index procedure and SXscore. CABG, coronary-artery bypass grafting; MT, medical-therapy; PCI, percutaneous coronary intervention. Abbreviations as in Table 1.

Table 3 Cox Regression Analysis to Evaluate the Effect of the Treatment on the Outcomes After Diagnostic Coronary Angiography with Adjustment for Confounding Factors

Outcome	Models^a	PCI*		CABG*
		HR (95% IC)	P value	HR (95% CI)	P value
All-cause death	1	0.49 (0.28–0.87)	0.014	1.15 (0.61–2.17)	0.676
	2	0.41 (0.16–1.05)	0.062	0.88 (0.28–2.74)	0.828
	3	0.41 (0.16–1.03)	0.057	0.72 (0.20–2.64)	0.622
Cardiovascular death	1	0.61 (0.27–1.36)	0.226	2.21 (0.98–4.98)	0.056
	2	0.26 (0.05–1.41)	0.120	2.28 (0.49–10.59)	0.293
	3	0.27 (0.05–1.43)	0.123	2.53 (0.42–15.10)	0.309
Myocardial infarction	1	1.10 (0.57–2.14)	0.772	1.94 (0.92–4.10)	0.082
	2	1.12 (0.38–3.29)	0.835	2.07 (0.66–6.47)	0.211
	3	1.12 (0.38–3.29)	0.839	1.66 (0.45–6.10)	0.447
Stroke	1	0.91 (0.26–3.12)	0.879	2.53 (0.71–9.03)	0.154
	2	0.67 (0.06–7.18)	0.670	8.67 (0.91–82.98)	0.061
	3	0.69 (0.06–7.54)	0.760	9.97 (0.57–174.58)	0.115
Heart failure	1	1.10 (0.63–1.92)	0.740	1.71 (0.87–3.34)	0.119
	2	1.31 (0.52–3.28)	0.566	1.99 (0.78–5.08)	0.152
	3	1.34 (0.53–3.39)	0.542	1.66 (0.61–4.53)	0.328
Late revascularization	1	1.78 (1.05–3.03)	0.034	0.85 (0.38–1.90)	0.689
	2	4.15 (1.67–10.29)	0.002	2.08 (0.63–6.88)	0.230
	3	3.63 (1.46–9.04)	0.006	1.24 (0.34–4.55)	0.750
MACCE-1	1	0.82 (0.49–1.37)	0.448	1.78 (1.01–3.14)	0.048
	2	0.80 (0.34–1.89)	0.603	2.57 (1.05–6.30)	0.039
	3	0.77 (0.32–1.84)	0.562	2.15 (0.73–6.31)	0.165
MACCE-2	1	1.31 (0.86–1.99)	0.216	1.82 (1.09–3.02)	0.021
	2	2.56 (1.27–5.17)	0.009	3.28 (1.45–7.41)	0.004
	3	2.35 (1.16–4.77)	0.018	2.17 (0.86–5.49)	0.100

Notes: *Medical treatment as reference treatment. ^aModel 1: adjusted for age, sex, and school degree; Model 2: adjusted for age, sex, school degree, BMI, DM, hypertension, chest pain, HDL-C, creatinine, hs-CRP, smoking, HF, LV ejection fraction and MI before the index procedure; and Model 3: adjusted for age, sex, school degree, BMI, DM, hypertension, chest pain, HDL-C, creatinine, hs-CRP, smoking, HF, LVEF, MI before the index procedure and SXscore.

Abbreviations: MACCE, major adverse cardiac and cerebral events; MACCE-1, composite of cardiovascular death, myocardial infarction and stroke; MACCE-2, outcomes of MACCE-1 plus late revascularization. Abbreviations as in Table 1.

Figure 3 Hazard ratio for MACCE-2 in participants stratified by diabetes mellitus, myocardial infarction, categories of systolic blood pressure, and left ventricular ejection fraction. *Adjusted for model 3 as. Table 3. **Normal for male ≥ 52% and for female ≥ 54%. Abbreviations as in Table 1.