What does complete revascularization mean in 2021? - Definitions, implications, and biases.

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Surgery

Background:

• Coronary artery disease (CAD) management often involves revascularization.
• The long-term impact of incomplete revascularization (ICR) versus complete revascularization (CR) remains debated.
• Optimizing revascularization strategies is crucial for patient outcomes.

Purpose of the Study:

• To review the current evidence and concepts of CR and ICR in coronary artery disease.
• To discuss the implications of CR versus ICR on long-term patient outcomes.
• To explore future perspectives in revascularization strategies.

Main Methods:

• Review of existing literature on complete and incomplete revascularization.
• Analysis of studies comparing outcomes of CR and ICR.
• Discussion of current and emerging assessment techniques.

Main Results:

• Complete revascularization is generally desirable when achievable.
• Incomplete revascularization can be a reasonable alternative, balancing risks and benefits.
• Fractional flow reserve (FFR) guidance may help identify appropriate revascularization targets and refine strategies.

Conclusions:

• The debate on CR versus ICR continues, with ICR being a viable option in certain scenarios.
• FFR-guided revascularization can improve the appropriateness of interventions.
• Hybrid revascularization strategies, guided by FFR, show promise, particularly for high-risk patients.