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Completeness of revascularization and its impact on the outcomes of a staged approach of percutaneous coronary intervention followed by minimally invasive valve surgery for patients with concomitant coronary artery and valvular heart disease
Author(s) -
Pineda Andrés M.,
Chandra Ramesh,
Gowani Saqib A.,
Santana Orlando,
Mihos Christos G.,
Kirtane Ajay J.,
Stone Gregg W.,
Kurlansky Paul,
Smith Craig R.,
Beohar Nirat
Publication year - 2016
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.26294
Subject(s) - medicine , revascularization , percutaneous coronary intervention , conventional pci , cardiology , coronary artery disease , surgery , concomitant , acute coronary syndrome , ejection fraction , artery , myocardial infarction , heart failure
Background A staged approach of percutaneous coronary intervention (PCI) followed by minimally invasive valve surgery (MIVS) is an alternative to the conventional combined coronary artery bypass and valve surgery for patients with concomitant coronary artery and valve disease. Limited data exist on degree of the completeness of revascularization achieved with this approach and its impact on outcomes. Methods A total of 138 patients, who underwent a staged approach between January 2009 and June 2013, were retrospectively evaluated. Coronary angiograms were reviewed by two cardiologists blinded to outcomes and were then categorized into two groups: complete or incomplete revascularization, which was defined as ≥1 major epicardial coronary arteries of at least 2.0 mm diameter with ≥70% untreated obstruction after the index PCI and before MIVS. Results Complete and incomplete revascularization was achieved in 105 (76%) and 33 (24%) patients, respectively. The patients with incomplete revascularization had a lower ejection fraction, a higher STS score, and more prior myocardial infarctions and multi‐vessel coronary artery disease. There were no differences in the post‐operative complications, 30‐day mortality, or 3‐year survival (84 vs. 83%, P = 0.68). After a median follow‐up of 29 months, incompletely revascularized patients had a higher incidence of acute coronary syndrome (2.9 vs. 12.9%, P = 0.05). Conclusions In patients undergoing a staged approach of PCI followed by MIVS, incomplete revascularization did not significantly impact the short or mid‐term survival, but was associated with an increased incidence of acute coronary syndrome at follow‐up. © 2015 Wiley Periodicals, Inc.