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Updated: Mar 8, 2026
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Incomplete Revascularization Is Associated With an Increased Risk for Major Adverse Cardiovascular Events Among
Ehrin J Armstrong1, Laura A Graham2, Stephen W Waldo1
1Section of Cardiology, Denver VA Medical Center and University of Colorado School of Medicine, Aurora, Colorado.
Insights
Incomplete revascularization after percutaneous coronary intervention (PCI) increases the risk of major adverse cardiovascular events (MACE) and myocardial infarction (MI) following noncardiac surgery. This risk is particularly high if surgery occurs within six weeks of PCI.
Area of Science:
- Cardiology
- Vascular Surgery
- Interventional Cardiology
Background:
- Patients with coronary artery disease (CAD) often undergo noncardiac surgery after percutaneous coronary intervention (PCI).
- Revascularization after PCI can be complete (all lesions treated) or incomplete (some lesions untreated).
- The implications of incomplete revascularization on perioperative outcomes are not fully understood.
Purpose of the Study:
- To investigate the association between incomplete revascularization and major adverse cardiovascular events (MACE) and myocardial infarction (MI).
- To assess the impact of incomplete revascularization on outcomes following noncardiac surgery in patients with CAD.
Main Methods:
- Retrospective analysis of 4,332 patients from the Veterans Affairs Clinical Assessment, Reporting, and Tracking program.
- Linking Veterans Affairs and non-Veterans Affairs surgical records for patients undergoing noncardiac surgery within two years of stent placement.
- Defining incomplete revascularization based on residual stenosis thresholds (≥50% left main, ≥70% other major epicardial arteries).
Main Results:
- Incomplete revascularization (34.7% of patients) was associated with a 19% increased odds of 1-month post-operative MACE.
- Post-operative myocardial infarction (MI) risk was significantly higher (37% increased odds) in patients with incomplete revascularization.
- Risk of MI was substantially elevated if noncardiac surgery was performed within six weeks of PCI (adjusted odds ratio: 1.84).
- Each additional vessel with incomplete revascularization increased MI odds by 17%.
Conclusions:
- Incomplete revascularization in CAD patients is linked to a higher risk of MI after noncardiac surgery.
- The timing of noncardiac surgery relative to PCI significantly influences post-operative MI risk.
- The extent of incomplete revascularization correlates with increased MI risk.
Objectives:
The aim of this study was to determine whether incomplete revascularization is associated with a higher risk for major adverse cardiovascular events (MACE) and myocardial infarction (MI) among patients undergoing noncardiac surgery.
Background:
Patients with coronary artery disease and prior percutaneous coronary intervention (PCI) frequently undergo noncardiac surgery. These patients may have had PCI either on all obstructive lesions (i.e., complete revascularization) or only on some (i.e., incomplete revascularization).
Methods:
Patients were identified using the Veterans Affairs Clinical Assessment, Reporting, and Tracking program. Veterans Affairs and non-Veterans Affairs surgical records were used to link patients who underwent noncardiac surgery within 2 years after stent placement. Incomplete revascularization was defined as a residual stenosis of ≥50% in the left main coronary artery or ≥70% in another major epicardial coronary artery on the basis of operator visual estimate.
Results:
In total, 4,332 patients (34.7%) had incomplete revascularization. A total of 567 MACE occurred within 1 month post-operatively. Patients with incomplete revascularization had an unadjusted 19% increased odds of post-operative MACE, compared with those with complete revascularization (odds ratio: 1.19; 95% confidence interval [CI]: 1.00 to 1.41). Among the MACE components, post-operative MI appears to contribute the most, with a 37% increased risk for post-operative MI among patients with incomplete revascularization (odds ratio: 1.37; 95% CI: 1.10 to 1.70). After adjustment, there was a significant interaction between time from PCI and outcomes after noncardiac surgery; incomplete revascularization was associated with significantly increased risk for post-operative MI primarily if surgery was performed within 6 weeks after PCI (adjusted odds ratio: 1.84; 95% CI: 1.04 to 2.38). The number of vessels with incomplete revascularization was also associated with an increased risk for post-operative MI: for each additional vessel with incomplete revascularization, there was a 17% increased odds of post-operative MI.
Conclusions:
Incomplete revascularization among patients with coronary artery disease is associated with an increased risk for MI after noncardiac surgery.
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