Complete versus incomplete coronary revascularization: definitions, assessment and outcomes

Area of Science:

• Cardiology
• Interventional Cardiology

Background:

• Coronary artery disease (CAD) is a major global health burden.
• Revascularization via percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery benefits selected patients with obstructive CAD.
• Complete revascularization (CR) is often associated with improved survival and fewer adverse cardiovascular events compared to incomplete revascularization (ICR) in multivessel disease.

Purpose of the Study:

• To critically appraise the evidence linking different types of ICR to adverse outcomes in patients with multivessel disease.
• To provide practical recommendations for revascularization strategies in high-risk patients with multivessel disease.
• To identify areas for future clinical research in revascularization.

Main Methods:

• Systematic review and critical appraisal of existing literature.
• Analysis of studies comparing CR versus ICR in various patient cohorts.
• Evaluation of factors influencing the feasibility of achieving CR.

Main Results:

• Evidence suggests that ICR is associated with adverse outcomes in patients with multivessel disease across different clinical presentations (stable IHD, NSTE-ACS, STEMI).
• Factors such as patient comorbidities, anatomical complexity, and procedural limitations often hinder the achievement of CR.
• Comparisons between CR and ICR are complicated by confounding factors, impacting real-world applicability.

Conclusions:

• Incomplete revascularization in multivessel coronary artery disease is linked to poorer clinical outcomes.
• Achieving complete revascularization is not always feasible, necessitating careful consideration of risks and benefits.
• Optimizing revascularization strategies is crucial for improving long-term outcomes in high-risk patients.