Reassessing the importance of complete versus incomplete coronary revascularization

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Cardiac Surgery

Background:

• Coronary revascularization aims to alleviate angina, myocardial infarction, and mortality.
• Complete revascularization is a recognized goal in coronary artery bypass grafting (CABG).
• Emerging data support complete revascularization's benefits after percutaneous coronary intervention (PCI).

Purpose of the Study:

• To evaluate the impact of complete versus incomplete coronary revascularization on clinical outcomes.
• To determine the association between revascularization completeness and adverse cardiovascular events.
• To assess the role of revascularization completeness in the choice of treatment modality.

Main Methods:

• Analysis of clinical outcomes following CABG and PCI.
• Assessment of the relationship between completeness of revascularization and adverse events.
• Evaluation of the residual SYNTAX score as a measure of angiographic complexity and completeness.

Main Results:

• Incomplete revascularization is linked to higher mortality post-CABG and PCI.
• Incomplete PCI is associated with increased myocardial infarction, repeat revascularization, and major adverse cardiovascular or cerebrovascular events.
• The degree of revascularization completeness, including lesion complexity (residual SYNTAX score), correlates with long-term outcomes.

Conclusions:

• Complete revascularization is crucial for optimizing long-term clinical outcomes in both CABG and PCI.
• Incomplete revascularization significantly increases the risk of adverse events and mortality.
• The ability to achieve complete revascularization should be a factor in selecting the optimal revascularization strategy.