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Impact of completeness of percutaneous coronary intervention revascularization on long-term outcomes in the stent era
Edward L Hannan1, Michael Racz, David R Holmes
1State University of New York, University at Albany, Rensselaer, NY 12144-3456, USA. elh03@health.state.ny.us
Insights
Incomplete revascularization after stenting for multivessel disease increases long-term mortality risk. Achieving complete revascularization is crucial for better patient outcomes in percutaneous coronary intervention.
Area of Science:
- Cardiology
- Interventional Cardiology
- Health Outcomes Research
Background:
- The clinical significance of complete revascularization (CR) versus incomplete revascularization (IR) following percutaneous coronary intervention (PCI) for multivessel disease remains incompletely understood, particularly outside of controlled trial settings.
- Limited data exists on the long-term impact of IR on patient survival and need for further procedures.
Purpose of the Study:
- To compare long-term mortality and the incidence of subsequent revascularization between patients who achieved CR and those with IR after PCI.
- To evaluate the impact of IR on patient outcomes using real-world data.
Main Methods:
- Retrospective analysis of patients undergoing PCI for multivessel disease from the New York State Percutaneous Coronary Interventions Reporting System.
- Patients were categorized into CR and IR groups, with specific focus on IR subsets including those with total occlusions and multiple IR vessels.
- Outcomes were compared after adjusting for baseline risk factors such as age, comorbidities, ejection fraction, renal disease, and stroke history.
Main Results:
- A significant proportion of patients (68.9%) with multivessel disease treated with stenting had IR.
- After risk adjustment, patients with IR demonstrated a significantly higher likelihood of long-term mortality (adjusted hazard ratio=1.15; 95% CI, 1.01 to 1.30).
- Patients with total occlusions and multiple IR vessels faced the highest mortality risk compared to CR patients (hazard ratio=1.36; 95% CI, 1.12 to 1.66).
Conclusions:
- Incomplete revascularization during stenting for multivessel disease is associated with poorer long-term survival.
- Clinical decisions should consider strategies to achieve CR, alternative treatments like coronary artery bypass grafting surgery, or enhanced post-discharge monitoring for patients with IR.
Background:
The importance of completeness of revascularization by percutaneous coronary intervention in patients with multivessel disease is unclear in that there is little information on the impact of incomplete revascularization outside of randomized trials. The objective of this study is to compare long-term mortality and subsequent revascularization for percutaneous coronary intervention patients receiving stents who were completely revascularized (CR) with those who were incompletely revascularized (IR).
Methods And Results:
Patients from New York State's Percutaneous Coronary Interventions Reporting System were subdivided into patients who were CR and IR. Then subsets of IR patients were contrasted with CR patients. Differences in long-term survival and subsequent revascularization for CR and IR patients were compared after adjustment for differences in preprocedural risk. A total of 68.9% of all stent patients with multivessel disease who were studied were IR, and 30.1% of all patients had total occlusions and/or > or =2 IR vessels. At baseline, the following patients were at higher risk: those who were older and those with more comorbid conditions, worse ejection fraction, and more renal disease and stroke. After adjustment for these baseline differences, IR patients were significantly more likely to die at any time (adjusted hazard ratio=1.15; 95% confidence interval, 1.01 to 1.30) than CR patients. IR patients with total occlusions and a total of > or =2 IR vessels were at the highest risk compared with CR patients (hazard ratio=1.36; 95% confidence interval, 1.12 to 1.66).
Conclusions:
IR with stenting is associated with an adverse impact on long-term mortality, and consideration should be given to either achieving CR, opting for surgery, or monitoring percutaneous coronary intervention patients with IR more closely after discharge.
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