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Long-Term Outcome of Incomplete Revascularization After Percutaneous Coronary Intervention in SCAAR (Swedish Coronary
Kristina Hambraeus1, Karin Jensevik2, Bo Lagerqvist3
1Department of Cardiology, Falun Hospital, Falun, Sweden; Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden.
Insights
Incomplete revascularization after percutaneous coronary intervention for multivessel disease significantly increases the risk of death, myocardial infarction, and repeat procedures within one year.
Area of Science:
- Cardiology
- Interventional Cardiology
- Health Outcomes Research
Background:
- The clinical benefits of multivessel percutaneous coronary intervention (PCI) remain a subject of debate.
- Assessing the completeness of revascularization is crucial for patient outcomes.
Purpose of the Study:
- To evaluate current practices in achieving complete revascularization (CR) in patients with multivessel disease undergoing PCI.
- To determine the association between incomplete revascularization (IR) and adverse cardiac events, including death, myocardial infarction (MI), and repeat revascularization.
Main Methods:
- A nationwide registry study using the SCAAR registry (2006-2010) identified 23,342 patients with multivessel disease.
- Data were merged with official Swedish health registries.
- IR was defined as untreated significant stenosis (≥60%) in a major coronary artery supplying >10% of the myocardium.
Main Results:
- Patients with IR (n=15,165) were older, had more extensive coronary disease, and were more likely to present with ST-segment elevation MI compared to those with CR (n=8,177).
- One-year outcomes showed higher rates of all-cause mortality (7.1% vs 3.8%), MI (10.4% vs 6.0%), and repeat revascularization (20.5% vs 8.5%) in the IR group.
- Adjusted analyses using propensity scores revealed a significantly higher hazard ratio for the composite of death, MI, or repeat revascularization at 1 year in patients with IR (HR 2.12; 95% CI: 1.98-2.28).
Conclusions:
- Incomplete revascularization in patients with multivessel disease undergoing PCI is linked to a substantial increase in adverse cardiac events within one year post-discharge.
- These findings underscore the importance of achieving complete revascularization to improve patient outcomes.
Objectives:
The aim of this study was to describe current practice regarding completeness of revascularization in patients with multivessel disease undergoing percutaneous coronary intervention (PCI) and to investigate the association of incomplete revascularization (IR) with death, repeat revascularization, and myocardial infarction (MI) in a large nationwide registry.
Background:
The benefits of multivessel PCI are controversial.
Methods:
Between 2006 and 2010 we identified 23,342 patients with multivessel disease in the SCAAR (Swedish Coronary Angiography and Angioplasty Registry) and merged data with official Swedish health data registries. IR was defined as any nontreated significant (60%) stenosis in a coronary artery supplying >10% of the myocardium.
Results:
Patients with IR (n = 15,165) were older, had more extensive coronary disease, and more often had ST-segment elevation MI at presentation than those with complete revascularization (CR) (n = 8,177). All-cause 1-year mortality, MI, and repeat revascularization were higher in IR than CR: 7.1% versus 3.8%, 10.4% versus 6.0%, and 20.5% versus 8.5%, respectively. Propensity score methodology was used in the adjusted analyses. Adjusted hazard ratio (HR) for the composite of death, MI, or repeat revascularization at 1 year was higher in IR than CR: 2.12 (95% confidence interval [CI]: 1.98 to 2.28; p < 0.0001). Adjusted HR for death and the combination of death/MI were 1.29 (95% CI: 1.12 to 1.49; p = 0.0005) and 1.42 (95% CI: 1.30 to 1.56; p < 0.0001), respectively.
Conclusions:
Incomplete revascularization at the time of hospital discharge in patients with multivessel disease undergoing PCI is associated with a high risk of recurrent 1-year adverse cardiac events.