Association between completeness of percutaneous coronary revascularization and postprocedure outcomes

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Health Outcomes Research

Background:

• Multivessel coronary artery disease (CAD) revascularization can be achieved via percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG).
• While complete revascularization is crucial in CABG, its impact on PCI outcomes remains understudied.
• This study investigates predictors and outcomes of complete multivessel PCI.

Purpose of the Study:

• To identify predictors of achieving complete revascularization in patients undergoing multivessel PCI.
• To evaluate the association between complete multivessel PCI and patient survival, need for subsequent CABG, and repeat PCI.

Main Methods:

• Utilized data from the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH) registry.
• Compared outcomes of 1308 patients with complete multivessel PCI to 648 patients with incomplete revascularization.
• Analyzed predictors including Duke jeopardy score, total occlusion, age, renal failure, and left ventricular function.

Main Results:

• Significant predictors of complete revascularization included higher Duke jeopardy score, total occlusion, year of PCI, age > 65, renal failure, and left ventricular function.
• Complete multivessel PCI was associated with a reduced hazard ratio for subsequent CABG (0.55) and a trend toward reduced mortality (0.75).
• No significant difference was observed in the rate of repeat PCI (HR 0.93) between complete and incomplete revascularization groups.

Conclusions:

• Baseline angiographic and clinical factors predict the ability to achieve complete revascularization during multivessel PCI.
• Complete multivessel PCI is linked to a lower likelihood of requiring future CABG and suggests improved survival.
• The strategy does not appear to impact the need for repeat PCI.