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Long‐term outcomes of complete versus incomplete revascularization after drug‐eluting stent implantation in patients with multivessel coronary disease
Author(s) -
Gao Zhan,
Xu Bo,
Yang Yuejin,
Yuan Jinqing,
Chen Jue,
Chen Jilin,
Qiao Shubin,
Wu Yongjian,
Yan Hongbin,
Gao Runlin
Publication year - 2013
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.24799
Subject(s) - medicine , cardiology , revascularization , drug eluting stent , coronary artery disease , coronary disease , stent , disease , drug , surgery , coronary heart disease , restenosis , myocardial infarction , pharmacology
Background A limited number of studies on the impact of complete revascularization (CR) vs. incomplete revascularization (IR) on long‐term outcomes in patients with multivessel coronary disease (MVD) in current percutaneous coronary intervention (PCI) practice have yielded inconsistent results. Methods Between April 2004 and November 2010, 7,376 consecutive patients with MVD underwent PCI at the Fuwai Hospital in Beijing, China. Patients who underwent prior CABG and those who had an acute myocardial infarction (MI) within 24 hr before revascularization or presented with cardiogenic shock were excluded. Angiographic CR was defined as successful angioplasty of all diseased lesions in the major epicardial coronary vessels and their first degree side branches (diameter ≥2.5 mm), and proximal CR was defined as successful angioplasty of all diseased proximal arteries. Results Among 7,065 patients with MVD undergoing PCI treatment, angiographic CR was performed in 1,188 patients (16.8%), and proximal CR in 2,053 patients (29.1%). The study found that either angiographic or proximal IR were associated with significantly higher estimated 3‐year rate of cardiac death (2.55% vs. 1.13%, log‐rank P = 0.016; and 2.70% vs. 1.43%, log‐rank P = 0.024, respectively). After adjustment for differences in baseline characteristics between IR and CR patients, angiographic IR was associated with a significantly higher rate of cardiac death (adjusted hazards ratio [HR]: 2.56, 95% confidence interval [CI]: 1.03–6.41) while proximal IR was associated with a numerically higher rate of cardiac death (adjusted HR: 1.72, 95% CI: 0.93–3.17). For the subgroup of ≥2‐vessel IR with total occlusion, either angiographic or proximal IR patients had significantly higher rate of cardiac death (adjusted HR: 4.25, 95% CI: 1.50–12.09; and adjusted HR: 3.02, 95% CI: 1.40–6.52, respectively). Conclusion Compared with IR, patients with CR had better clinical outcomes, supporting CR as first choice for patients with MVD. © 2013 Wiley Periodicals, Inc.