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Complete revascularization optimizes patient outcomes in multivessel coronary artery disease: Data from the
Timothy Williams1, Aaina Mittal1, Dimitar Karageorgiev2
1Sussex Cardiac Centre, Brighton and Sussex University Hospitals, UK.
Insights
Complete revascularization (CR) in patients with multivessel coronary artery disease (MVD) significantly improves clinical outcomes and reduces angina compared to incomplete revascularization (IR). Aiming for CR is recommended for better patient results.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- The optimal revascularization strategy for patients with multivessel coronary artery disease (MVD) remains under investigation.
- Complete revascularization (CR) versus incomplete revascularization (IR) in MVD patients requires further clarification.
Purpose of the Study:
- To evaluate the impact of complete revascularization (CR) versus incomplete revascularization (IR) on clinical outcomes in patients with MVD undergoing percutaneous coronary intervention (PCI).
Main Methods:
- Analysis of the e-Ultimaster registry including 15,441 patients with MVD treated with sirolimus-eluting stents.
- Physician assessment of revascularization completeness (CR vs. IR) during index hospitalization.
- Propensity-weighted analysis using inverse probability of treatment weights (IPTW) to compare outcomes at 1 year.
Main Results:
- Complete revascularization (CR) was achieved in 48.0% of MVD patients.
- CR was associated with significantly higher rates of angina-free status at 1 year (90.5% vs. 87.5%).
- CR demonstrated lower rates of target lesion failure (3.3% vs. 4.4%), patient-oriented composite endpoint (6.8% vs. 10.8%), and all-cause mortality (2.3% vs. 3.1%) compared to IR.
Conclusions:
- Physician-directed complete revascularization (CR) using sirolimus-eluting stents optimizes clinical outcomes and reduces angina in an all-comer MVD population.
- The findings support the recommendation to aim for complete revascularization (CR) in patients with MVD.
Objectives:
The aim of this analysis was to assess the effect of the coronary revascularization strategy during index admission on clinical outcomes among patients undergoing percutaneous coronary intervention (PCI) with multivessel coronary artery disease (MVD).
Background:
The value of complete revascularization (CR) over incomplete revascularization (IR) in MVD patients is not fully established.
Methods:
Patients with MVD defined as ≥2 major epicardial vessels with ≥50% stenosis were selected from the observational all-comer e-Ultimaster registry. Patients were treated with a sirolimus-eluting thin-strut coronary stent. Completeness of revascularization was physician assessed at the index procedure or an eventually staged procedure during the index hospitalization. Outcomes measures at 1 year were target lesion failure (TLF) (composite of cardiac death, target vessel-related myocardial infarction [MI], and clinically driven target lesion revascularization [TLR]), and patient-oriented composite endpoint (POCE) (all-cause mortality, MI, or revascularization). The inverse probability of treatment weights (IPTW) methodology was used to perform a matched analysis.
Results:
The registry recruited 37,198 patients of whom 15,441 (41.5%) had MVD. CR on hospital discharge was achieved in 7413 (48.0%) patients and IR in 8028 (52.0%) patients. Mean age was 64.6 ± 11.1 versus 65.7 ± 11.0 years (p < 0.01), male gender 77.9% and 77.3% (p = 0.41) and diabetes 31.3% versus 33.4% (p = 0.01) for CR and IR, respectively. Chronic stable angina patients more commonly underwent CR (47.6% vs. 36.8%, p < 0.01). After propensity weighted analysis, 90.5% of CR patients were angina-free at 1 year compared with 87.5% of IR patients (p < 0.01). TLF (3.3% vs. 4.4%; p < 0.01), POCE (6.8% vs. 10.8%; p < .01), and all-cause mortality (2.3% vs. 3.1%; p < .01) were all lower in CR patients.
Conclusions:
A physician-directed use of a CR strategy utilizing sirolimus-eluting thin-strut stent results in optimized clinical outcomes and less angina in an all-comer population. Our findings suggest that a CR should be aimed for.
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