Outcomes With Complete Versus Incomplete Revascularization in Patients With Multivessel Coronary Disease Undergoing Percutaneous Coronary Intervention With Everolimus Eluting Stents
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Published on: May 14, 2013
Sripal Bangalore1, Yu Guo1, Zaza Samadashvili2
1New York University School of Medicine, New York, New York.
Insights
Incomplete revascularization after percutaneous coronary intervention with everolimus-eluting stents in multivessel disease patients is linked to a higher risk of death and myocardial infarction. Achieving complete revascularization is crucial for better patient outcomes.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Technology
Background:
- Multivessel disease (MVD) poses significant risks to patients undergoing percutaneous coronary intervention (PCI).
- Everolimus-eluting stents (EES) are commonly used in PCI procedures.
- Completeness of revascularization (CR) is a critical factor influencing clinical outcomes.
Purpose of the Study:
- To evaluate the impact of CR on clinical outcomes in MVD patients treated with EES.
- To compare outcomes between complete revascularization (CR), attempted but failed CR, and incomplete revascularization (ICR).
Main Methods:
- Retrospective analysis of 15,046 MVD patients undergoing PCI with EES in New York State.
- Patients categorized into CR, attempted but failed CR, or ICR groups.
- Propensity score adjustment used to control for confounding variables.
- Primary outcome: death/myocardial infarction (MI); Secondary outcomes: composite endpoints and individual components.
Main Results:
- Only 30% of patients achieved CR.
- ICR was associated with a significantly higher risk of death/MI (HR 1.15; P=0.02) and death/MI/repeat revascularization (HR 1.19; P<0.0001) compared to CR.
- ICR also showed increased risk for death (HR 1.16; P=0.047) and repeat revascularization (HR 1.20; P<0.0001).
- Attempted but failed CR had intermediate risk between CR and ICR.
Conclusions:
- Incomplete revascularization in MVD patients treated with EES PCI is associated with significantly worse clinical outcomes.
- Achieving complete revascularization is essential for reducing the risk of major adverse cardiovascular events.
- Factors like the number of diseased vessels and chronic total occlusion predict incomplete revascularization.
Abstract:
The aim of the study was to evaluate the outcomes with completeness of revascularization (CR) in patients with multivessel disease (MVD) who underwent PCI using everolimus-eluting stent (EES). Patients with MVD who underwent PCI using EES in New York State were chosen. Patients were categorized into CR, attempted but failed CR or incomplete revascularization (ICR). The primary outcome was death/myocardial infarction (MI). Secondary outcomes were death/MI/repeat revascularization and the individual components of the composite outcomes. Multiple propensity score adjustment analysis was used to adjust for differences in covariates among the 3 groups. Among 15,046 patients, 4,545 (30%) had CR. The strongest predictors of ICR were the number of vessels diseased (χ2 = 428.48; p <0.0001) and presence of chronic total occlusion (CTO) (χ2 = 184.27; p <0.0001). In the multiple propensity score-adjusted analysis, over a mean follow-up of 2.9 years, compared with CR, ICR was associated with significant higher risk of death/MI (17.49% vs 12.69%; hazard ratio [HR] = 1.15; 95% confidence interval [CI] 1.02 to 1.29; p = 0.02), death/MI/repeat revascularization (48.01% vs 37.85%; HR = 1.19; 95% CI 1.12 to 1.27; p <0.0001), death (12.41% vs 8.63%; HR = 1.16; 95% CI 1.00 to 1.35; p = 0.047), and repeat revascularization (39.16% vs 31.63%; HR = 1.20; 95% CI 1.12 to 1.28; p <0.0001), with numerically higher rates of MI (7.18% vs 4.90%; HR = 1.17; 95% CI 0.98 to 1.40; p = 0.09). The risk with attempted but failed CR was intermediate between CR and ICR. In conclusion, in patients with MVD who underwent PCI with EES, incomplete revascularization is associated with significantly higher risk of cardiovascular events including death compared with complete revascularization.
