Completeness of revascularisation by percutaneous coronary intervention

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.