Patients with coronary artery disease not amenable to traditional revascularization: prevalence and 3-year mortality

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Medicine

Background:

• Severe coronary artery disease (CAD) poses a significant challenge, particularly when revascularization is not an option.
• Optimal medical therapy may not suffice for all patients with severe CAD and persistent angina.
• Contemporary data on the prevalence and outcomes of such patients are limited.

Purpose of the Study:

• To determine the current prevalence of coronary artery disease (CAD) not amenable to revascularization.
• To assess the 3-year all-cause mortality in patients with CAD unsuitable for revascularization.
• To compare outcomes between completely and incompletely revascularized CAD patients.

Main Methods:

• Review of clinical and angiographic data for 493 patients undergoing coronary angiography.
• Categorization of patients into six groups based on coronary artery disease severity and revascularization status.
• Determination of 3-year all-cause mortality across all patient groups.

Main Results:

• 14.8% had normal coronaries, 19.5% had <70% CAD, 36.9% had >70% CAD with complete revascularization, 12.8% had >70% CAD with partial revascularization, 9.3% had >70% CAD treated medically, and 6.7% had >70% CAD with no revascularization option.
• Three-year mortality rates were 2.7%, 6.3%, 8.2%, 12.7%, 17.4%, and 15.2% for the respective groups.
• Patients with incomplete revascularization (n=142) had significantly higher 3-year mortality (14.8%) compared to completely revascularized patients (n=351, 6.6%; P=0.004).

Conclusions:

• 28.8% of patients undergoing coronary angiography had significant CAD and did not achieve complete revascularization.
• This subgroup included partially revascularized, medically treated, and "no-option" patients.
• Incomplete revascularization in CAD patients is associated with significantly higher 3-year mortality.