Incomplete revascularization: what the surgeon needs to know

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Clinical Outcomes Research

Background:

• Complete revascularization (CR) historically improved survival and reduced reintervention in coronary artery bypass grafting (CABG).
• Advances, including percutaneous coronary intervention (PCI) for multivessel disease (MVD), prompt reevaluation of CR's necessity.
• Definitions of CR vary, encompassing anatomical and functional criteria.

Purpose of the Study:

• To review the evidence comparing complete revascularization (CR) versus incomplete revascularization (IR) in coronary artery disease treatment.
• To assess the impact of CR and IR on long-term survival and reintervention rates.
• To inform clinical decision-making regarding revascularization strategies.

Main Methods:

• Review of data from randomized controlled trials (RCTs) and registries over the past 3-4 decades.
• Analysis of post hoc data from existing RCTs.
• Comparison of CR achievement rates between CABG and PCI.

Main Results:

• CR is more frequently achieved with CABG than with PCI.
• Available data show a trend favoring improved outcomes with CR, irrespective of the revascularization strategy.
• No direct randomized controlled trials specifically compare CR versus IR.

Conclusions:

• CR generally demonstrates improved long-term results and reduced reintervention rates.
• The choice between CR and IR should be individualized by the heart team.
• Incomplete revascularization may be considered in hybrid strategies or rare cases where CR benefits are outweighed by costs.