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Impact of incomplete revascularization on long-term mortality after coronary stenting
Chuntao Wu1, Anne-Marie Dyer, Spencer B King
1Penn State Hershey College of Medicine, 600 Centerview Drive, Hershey, PA 17033, USA. chuntao.wu@psu.edu
Insights
Incomplete revascularization after stenting for multivessel disease may increase long-term mortality risk. This study found a marginally significant higher risk of death for incomplete revascularization patients over 8 years.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Health Outcomes Research
Background:
- The long-term impact of incomplete revascularization (IR) post-percutaneous coronary intervention (PCI) on patient outcomes remains unclear.
- Few studies have investigated mortality risks beyond 5 years following PCI for multivessel disease.
Purpose of the Study:
- To evaluate the association between incomplete revascularization (IR) and 8-year mortality risk in patients undergoing stenting for multivessel coronary disease.
Main Methods:
- Analysis of 13,016 patients with multivessel disease who underwent bare metal stent (BMS) procedures (1999-2000).
- Logistic regression used to predict complete revascularization (CR) probability; CR and IR patients were pair-matched.
- Long-term mortality tracked through 2007 using the National Death Index.
Main Results:
- Complete revascularization (CR) was achieved in 29.2% of patients.
- In pair-matched cohorts (n=3803), 8-year survival rates were 80.8% for CR versus 78.5% for IR (P=0.04).
- Incomplete revascularization (IR) showed a marginally significant increased risk of death (hazard ratio=1.12; 95% CI, 1.01-1.26; P=0.04).
Conclusions:
- Incomplete revascularization (IR) may be linked to increased long-term mortality risk after BMS stenting in multivessel disease patients.
- Further prospective research is warranted to confirm this association.
Background:
The impact of incomplete revascularization (IR) on adverse outcomes after percutaneous coronary intervention remains inconclusive, and few studies have examined mortality during follow-ups longer than 5 years. The objective of this study is to test the hypothesis that IR is associated with higher risk of long-term (8-year) mortality after stenting for multivessel coronary disease.
Methods And Results:
A total of 13 016 patients with multivessel disease who had undergone stenting procedures with bare metal stents in 1999 to 2000 were identified in the New York State's Percutaneous Coronary Intervention Reporting System. A logistic regression model was fit to predict the probability of achieving complete revascularization (CR) in these patients using baseline risk factors; then, the CR patients were matched to the IR patients with similar likelihoods of achieving CR. Each patient's vital status was followed through 2007 using the National Death Index, and the difference in long-term mortality between IR and CR was compared. It was found that CR was achieved in 29.2% (3803) of the patients. For the 3803 pair-matched patients, the respective 8-year survival rates were 80.8% and 78.5% for CR and IR (P=0.04), respectively. The risk of death was marginally significantly higher for IR (hazard ratio=1.12; 95% confidence interval, 1.01-1.26, P=0.04). The 95% bootstrap confidence interval for the hazard ratio was 0.98 to 1.32.
Conclusions:
IR may be associated with higher risk of long-term mortality after stenting with BMS in patients with multivessel disease. More prospective studies are needed to further test this association.
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