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Published on: May 14, 2013
Complete versus incomplete revascularization in patients with multivessel coronary artery disease treated with
Mineok Chang1, Jung-Min Ahn1, Nayoung Kim2
1Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Insights
Incomplete revascularization after drug-eluting stent PCI for multivessel coronary artery disease did not increase death risk but significantly raised myocardial infarction risk. This finding impacts treatment decisions for complex CAD patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- The clinical significance of complete revascularization versus incomplete revascularization in multivessel coronary artery disease (CAD) patients undergoing percutaneous coronary intervention (PCI) is not fully understood.
- Adverse cardiovascular events associated with varying degrees of revascularization require further investigation.
Purpose of the Study:
- To evaluate the impact of complete revascularization (CR) versus incomplete revascularization (IR) on adverse cardiovascular events in patients with multivessel CAD treated with drug-eluting stents (DES).
- To compare the risks of death, myocardial infarction (MI), stroke, and repeat revascularization between CR and IR groups.
Main Methods:
- Analysis of consecutive patients with multivessel CAD undergoing PCI with DES between 2003 and 2013.
- Utilized propensity-score matching to create comparable cohorts for CR and IR groups.
- Primary outcome: all-cause death. Secondary outcomes: MI, stroke, and repeat revascularization.
Main Results:
- 1402 matched pairs of patients in CR and IR groups were identified from 3901 patients.
- At a median follow-up of 4.9 years, IR showed similar risks of death (HR 1.03), stroke (HR 1.26), and repeat revascularization (HR 1.15) compared to CR.
- However, IR was associated with a significantly higher risk of MI (HR 1.86) compared to CR.
Conclusions:
- In patients with multivessel CAD treated with DES, incomplete revascularization is associated with a similar risk of death compared to complete revascularization.
- Incomplete revascularization significantly increases the risk of myocardial infarction during follow-up in this patient population.
Background:
The clinical impact of completeness of revascularization on adverse cardiovascular events remains unclear among patients with multivessel coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI).
Methods:
This analysis included consecutive patients with multivessel CAD, who underwent PCI with drug-eluting stents (DES) during the period from January 1, 2003, through to December 31, 2013. We compared the outcomes in patients, who achieved complete (CR) versus incomplete revascularization (IR) at the time of PCI. The primary outcome was death from any cause. Secondary outcomes were the rates of myocardial infarction (MI), stroke, and repeat revascularization. Propensity-score matching was used to assemble a cohort of patients with similar baseline characteristics.
Results:
Among 3901 patients with multivessel CAD treated with DES, 1402 pairs of similar propensity scores in each group of CR and IR were identified. At a median follow-up of 4.9 years (interquartile range, 2.4-7.5), IR was associated with a similar risk of death (hazard ratio [HR], 1.03; 95% CI, 0.80-1.32; P=.83) as compared with CR. IR was also associated with similar risks of stroke (HR, 1.26; 95% CI, 0.76-2.09; P=.37) and repeat revascularization (HR, 1.15; 95% CI, 0.93-1.41; P=.19), but associated with a higher risk of MI (HR, 1.86; 95% CI, 1.08-3.19; P=.024) compared to CR.
Conclusions:
Among patients with multivessel CAD treated with DES, as compared with CR, IR was associated with similar risk of death. However, IR was associated with a higher risk of MI during follow-up.
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