Impact of Angiographic Complete Revascularization After Drug-Eluting Stent Implantation or Coronary Artery Bypass Graft Surgery for Multivessel Coronary Artery Disease
- 31 May 2011
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Circulation
- Vol. 123 (21), 2373-2381
- https://doi.org/10.1161/circulationaha.110.005041
Abstract
Background—: This study sought to evaluate the clinical impact of angiographic complete revascularization (CR) after drug-eluting stent implantation or coronary artery bypass graft surgery for multivessel coronary disease. Methods and Results—: A total of 1914 consecutive patients with multivessel coronary disease undergoing drug-eluting stent implantation (1400 patients) or coronary artery bypass graft surgery (514 patients) were enrolled. Angiographic CR was defined as revascularization in all diseased segments according to the Synergy Between PCI With Taxus and Cardiac Surgery classification. The outcomes of patients undergoing CR were compared with those undergoing incomplete revascularization (IR) after adjustments with the inverse-probability-of-treatment weighting method. Angiographic CR was performed in 917 patients (47.9%) including 573 percutaneous coronary intervention (40.9%) and 344 coronary artery bypass graft (66.9%) patients. CR patients were younger and had more extensive coronary disease than IR patients. Over 5 years, CR patients had comparable incidences of death (8.9% versus 8.9%; adjusted hazard ratio, 1.04; 95% confidence interval, 0.76 to 1.43; P =0.81), the composite of death, myocardial infarction, and stroke (12.1% versus 11.9%; adjusted hazard ratio, 1.04; 95% confidence interval, 0.79 to 1.36; P =0.80), and the composite of death, myocardial infarction, stroke, and repeat revascularization (22.4% versus 24.9%; adjusted hazard ratio, 0.91; 95% confidence interval, 0.75 to 1.10; P =0.32) compared with IR patients. However, 368 patients (19.2%) with multivessel IR had a greater tendency toward higher risk of death, myocardial infarction, stroke, or repeat revascularization (30.3% versus 22.1%; adjusted hazard ratio, 1.27; 95% confidence interval, 0.97 to 1.66; P =0.079) than those without multivessel IR. Conclusions—: Angiographic CR with drug-eluting stent implantation or coronary artery bypass grafting did not improve long-term clinical outcomes in patients with multivessel disease. This finding supports the strategy of ischemia-guided revascularization.This publication has 24 references indexed in Scilit:
- Complete Percutaneous Revascularization for Multivessel Disease in Patients With Impaired Left Ventricular Function: Pre- and Post-Procedural Evaluation by Cardiac Magnetic Resonance ImagingJACC: Cardiovascular Interventions, 2010
- Impact of Incomplete Revascularization Following OPCAB SurgeryJournal of Cardiac Surgery, 2009
- Evaluation of Revascularization Subtypes in Octogenarians Undergoing Coronary Artery Bypass GraftingCirculation, 2009
- Does Reasonable Incomplete Surgical Revascularization Affect Early or Long-Term Survival in Patients With Multivessel Coronary Artery Disease Receiving Left Internal Mammary Artery Bypass to Left Anterior Descending Artery?Circulation, 2009
- Long-Term Safety and Effectiveness of Unprotected Left Main Coronary Stenting With Drug-Eluting Stents Compared With Bare-Metal StentsCirculation, 2009
- Comparison of radial artery patency according to proximal anastomosis site: Direct aorta to radial artery anastomosis is superior to radial artery composite graftingThe Journal of Thoracic and Cardiovascular Surgery, 2009
- Long-Term Mortality After Percutaneous Coronary Intervention With Drug-Eluting Stent Implantation Versus Coronary Artery Bypass Surgery for the Treatment of Multivessel Coronary Artery DiseaseCirculation, 2008
- Impact of Completeness of Percutaneous Coronary Intervention Revascularization on Long-Term Outcomes in the Stent EraCirculation, 2006
- ACC/AHA 2004 Guideline Update for Coronary Artery Bypass Graft Surgery: Summary ArticleCirculation, 2004
- What constitutes optimal surgical revascularization?: Answers from the bypass angioplasty revascularization investigation (BARI)Journal of the American College of Cardiology, 2002