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Completeness of revascularisation by percutaneous coronary intervention
Insights
Complete revascularisation by percutaneous coronary intervention (PTCA) in multivessel coronary disease did not lower adverse cardiac events. Patients with three or more remaining lesions after PTCA had a worse prognosis than those undergoing coronary artery bypass grafting (CABG).
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Multivessel coronary artery disease (CAD) poses significant risks for adverse cardiac events.
- Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are primary revascularization strategies.
- The impact of complete versus incomplete revascularization by PCI on patient outcomes requires further elucidation.
Purpose of the Study:
- To assess the association between the completeness of revascularization achieved with PCI and the incidence of adverse cardiac events within one year.
- To compare outcomes in patients with multivessel CAD undergoing PCI with varying degrees of revascularization completeness.
- To compare PCI outcomes with those of CABG.
Main Methods:
- The Coronary Angioplasty versus Bypass Revascularisation Investigation (CABRI) enrolled patients with stable or unstable angina or exercise-induced ischemia.
- Patients were randomized to either CABG (n=513) or PTCA (n=541).
- Revascularization by PTCA was deemed complete if no stenotic lesions (<50% diameter stenosis) remained post-procedure. Outcomes were compared across PTCA subgroups with 0, 1, 2, or 3+ remaining lesions and with CABG patients.
Main Results:
- Complete revascularization was achieved in 27% of PTCA patients; 27% had one, 23% had two, and 22% had three or more remaining lesions.
- One-year rates of death or myocardial infarction (MI) did not differ significantly across PTCA subgroups (9.5% to 12.6%, p=0.225).
- Patients with three or more remaining lesions after PTCA had significantly higher rates of death or MI compared to CABG patients (12.6% vs 6.2%, p=0.017).
- Repeat interventions were significantly higher after PTCA (29.3% to 51.3%) compared to CABG (3.5%, p<0.001).
Conclusions:
- Complete revascularization by PTCA in multivessel CAD does not reduce the risk of death or MI compared to incomplete revascularization.
- Overall patient prognosis after PTCA is comparable to CABG.
- Patients with three or more residual lesions after PTCA experience a worse prognosis than those treated with CABG.
Objective:
To evaluate the relationship between the completeness of revascularisation by percutaneous coronary intervention and the one-year occurrence of adverse cardiac events in patients with multivessel disease.
Patients:
Patients with stable or unstable angina pectoris, or with exercise-induced ischaemia, were enrolled in the Coronary Angioplasty versus Bypass Revascularisation Investigation (CABRI).
Methods:
In CABRI, patients were randomised to coronary bypass grafting (CABG; n=513) or angioplasty (PTCA; n=541). Revascularisation in patients randomised to PTCA was defined as complete if no lesions with a diameter stenosis <50% remained post-procedure. Patients with complete revascularisation were distinguished from those with one, two, and three or more remaining lesions, respectively. Differences in baseline characteristics and in the one-year occurrence of death, myocardial infarction, (re)CABG, and (re)PTCA between these subgroups were evaluated. Comparisons were made with patients randomised to CABG.
Results:
Complete revascularisation was obtained in 148 patients randomised to PTCA (27%). In 147 (27%) cases one lesion remained, while there were 122 (23%) and 119 (22%) patients with two and three or more remaining lesions, respectively. Five (1%) patients could not be classified. The one-year rates of either death or MI were 9.5%, 5.4%, 8.2%, and 12.6% in the respective PTCA subgroups (p=0.225), and 6.2% in patients randomised to CABG (comparison with three or more remaining lesions after PTCA: p=0.017). The percentages of repeat interventions during one-year follow-up were 29.7%, 29.3%, 39.3%, and 51.3% (p<0.001), much higher than after CABG (3.5%; p<0.001).
Conclusion:
Complete revascularisation by PTCA in multivessel coronary disease did not result in a lower death or MI rate compared with incomplete revascularisation. Overall the patient's prognosis after PTCA is similar to CABG, but patients with three or more remaining lesions after PTCA had a worse prognosis than CABG patients.
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