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Published on: May 14, 2013

Complete versus incomplete revascularization in patients with multivessel disease undergoing percutaneous coronary

Corrado Tamburino1, Dominick J Angiolillo, Piera Capranzano

  • 1Division of Cardiology, University of Catania, Catania, Italy.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|September 25, 2008
PubMed

Insights

Achieving complete revascularization with drug-eluting stents (DES) in multivessel coronary artery disease (MVD) patients significantly lowers long-term adverse events, including cardiac death and myocardial infarction.

Area of Science:

  • Interventional Cardiology
  • Cardiovascular Medicine
  • Medical Device Technology

Background:

  • Coronary artery bypass grafting (CABG) in multivessel coronary artery disease (MVD) patients demonstrates improved outcomes with complete revascularization.
  • Limited data exists on the comparative effectiveness of complete versus incomplete revascularization using percutaneous coronary intervention (PCI) with drug-eluting stents (DES) in MVD patients.

Purpose of the Study:

  • To evaluate the long-term prognostic significance of complete versus incomplete revascularization in MVD patients treated with PCI and DES.
  • To compare the incidence of major adverse cardiovascular events between complete and incomplete revascularization strategies in this patient cohort.

Main Methods:

  • A cohort of 508 MVD patients undergoing PCI with sirolimus- or paclitaxel-eluting stents were analyzed.
  • Patients were categorized into complete (212) and incomplete (296) revascularization groups.
  • The primary outcome was a composite of cardiac death, nonfatal myocardial infarction (MI), or any repeat revascularization, with a median follow-up of 27 months.

Main Results:

  • Complete revascularization was associated with a significantly lower risk of the primary composite endpoint (HR: 0.43; P < 0.0001) after adjustment.
  • Specific benefits included reduced rates of cardiac death (HR: 0.37; P = 0.03) and composite of cardiac death or MI (HR: 0.34; P = 0.008).
  • Complete revascularization also significantly reduced the need for any repeat revascularization (HR: 0.45; P = 0.0003), findings consistent in propensity-matched analysis.

Conclusions:

  • Complete revascularization using drug-eluting stents in MVD patients leads to superior long-term clinical outcomes.
  • This strategy is associated with a significant reduction in major adverse cardiovascular events and repeat procedures.
Abstract

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