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Published on: June 12, 2021
Complete revascularization in patients undergoing multivessel PCI is an independent predictor of improved long-term
Ralf Lehmann1, Stephan Fichtlscherer, Volker Schächinger
1Department of Cardiology, Goethe-University Frankfurt, Frankfurt, Germany.
Insights
Complete revascularization (CR) after multivessel percutaneous coronary intervention (MV-PCI) significantly improves survival. Achieving CR by ensuring no residual stenosis in all coronary segments is key for better long-term outcomes in MV-CAD patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Prognostic significance of complete revascularization (CR) is established for surgical revascularization but less clear for percutaneous coronary intervention (PCI) in multivessel coronary artery disease (MV-CAD).
- Varied definitions of CR complicate the interpretation of clinical studies.
- Assessing CR's impact on long-term survival after MV-PCI is crucial.
Purpose of the Study:
- To evaluate predictors of incomplete revascularization after MV-PCI.
- To assess the prognostic impact of CR on long-term overall survival in MV-CAD patients undergoing PCI.
- To compare different CR definitions in the context of MV-PCI.
Main Methods:
- Retrospective analysis of procedural characteristics and long-term survival in 679 consecutive "all-comer" MV-CAD patients undergoing PCI.
- Application of three CR definitions adapted from coronary artery bypass grafting (CABG) trials.
- Assessment of predictors for incomplete revascularization and the prognostic impact of CR.
Main Results:
- CR was achieved in 76%, 67%, and 95% based on the three definitions.
- Patients with incomplete revascularization were older, had lower ejection fraction, and more frequent acute coronary syndromes.
- CR was associated with an approximate 50% reduction in long-term mortality, with absence of residual stenosis in all segments being an independent predictor (HR=0.51, P=0.025).
Conclusions:
- Complete revascularization of all coronary segments is linked to improved overall survival following MV-PCI.
- Achieving CR, particularly the absence of residual stenosis in all segments, is a significant independent predictor of better long-term prognosis.
- Standardizing CR definitions is important for future research in MV-CAD.
Background:
The prognostic relevance of complete revascularization (CR) in patients with multivessel coronary artery disease (MV-CAD) has been established so far for surgical treatment strategies rather than for percutaneous coronary revascularization (PCI). In addition, different definitions of CR have further complicated the interpretation of clinical studies.
Methods:
Procedural characteristics and long-term overall survival were assessed in 679 consecutive "all-comer" patients, who underwent PCI in at least two main vessels. We adapted three definitions of CR from the coronary artery bypass grafting (CABG) trials. CR was achieved if following MV-PCI one of the three criteria was met: (1) no residual stenosis in a main coronary vessel, (2) no residual stenosis in any coronary segment, or (3) no residual stenosis in the left anterior descending (LAD) and at least one further main branch. The main objective was the evaluation of predictors of incomplete revascularization and the prognostic impact of CR in MV-PCI patients.
Results:
CR was achieved in 76%, 67%, and 95%, respectively, (definitions 1-3). Patients without CR were older, had a lower ejection fraction, and presented more often with acute coronary syndromes (ACS). Clinical long-term follow-up regarding survival was available in 664 patients (98%) with a mean follow-up of 2.5 +/- 1.6 years. Independent of the specific definition, CR was associated with a reduced long-term mortality by approximately 50%. After adjusting for relevant baseline parameters, only absence of residual stenosis in all coronary segments remained as an independent predictor of long-term prognosis (hazard ratio [HR]= 0.51, 95% confidence interval [CI]: 0.28-0.93; P = 0.025).
Conclusions:
CR of all coronary segments is associated with improved overall survival after MV-PCI.
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