Impact of completeness of percutaneous coronary intervention revascularization on long-term outcomes in the stent era

• Published in: Circulation (New York, N.Y.) Vol. 113; no. 20; pp. 2406 - 2412
• Main Authors: HANNAN, Edward L, RACZ, Michael, HOLMES, David R, KING, Spencer B, WALFORD, Gary, AMBROSE, John A, SHARMA, Samin, KATZ, Stanley, CLARK, Luther T, JONES, Robert H
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 23.05.2006
• Subjects: Adult; Aged; Aged, 80 and over; Angioplasty, Balloon, Coronary; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Clinical Trials as Topic; Coronary Disease - mortality; Coronary Disease - surgery; Coronary heart disease; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Female; Heart; Humans; Male; Medical sciences; Middle Aged; Myocardial Infarction - mortality; Myocardial Infarction - surgery; Myocardial Revascularization - adverse effects; Myocardial Revascularization - mortality; Myocardial Revascularization - standards; New York - epidemiology; Recurrence; Retrospective Studies; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Stents - adverse effects; Stroke Volume; Survival Rate; Treatment Outcome; New York; percutaneous coronary intervention; Prognosis; Mortality; stents; Cardiovascular disease; Instrumental dilatation; Coronary heart disease; Stent; Revascularization; Percutaneous route; angioplasty
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/CIRCULATIONAHA.106.612267

The importance of completeness of revascularization by percutaneous coronary intervention in patients with multivessel disease is unclear in that there is little information on the impact of incomplete revascularization outside of randomized trials. The objective of this study is to compare long-term mortality and subsequent revascularization for percutaneous coronary intervention patients receiving stents who were completely revascularized (CR) with those who were incompletely revascularized (IR). Patients from New York State's Percutaneous Coronary Interventions Reporting System were subdivided into patients who were CR and IR. Then subsets of IR patients were contrasted with CR patients. Differences in long-term survival and subsequent revascularization for CR and IR patients were compared after adjustment for differences in preprocedural risk. A total of 68.9% of all stent patients with multivessel disease who were studied were IR, and 30.1% of all patients had total occlusions and/or > or =2 IR vessels. At baseline, the following patients were at higher risk: those who were older and those with more comorbid conditions, worse ejection fraction, and more renal disease and stroke. After adjustment for these baseline differences, IR patients were significantly more likely to die at any time (adjusted hazard ratio=1.15; 95% confidence interval, 1.01 to 1.30) than CR patients. IR patients with total occlusions and a total of > or =2 IR vessels were at the highest risk compared with CR patients (hazard ratio=1.36; 95% confidence interval, 1.12 to 1.66). IR with stenting is associated with an adverse impact on long-term mortality, and consideration should be given to either achieving CR, opting for surgery, or monitoring percutaneous coronary intervention patients with IR more closely after discharge.