Clinical outcomes based on completeness of revascularisation in patients undergoing percutaneous coronary intervention: a meta-analysis of multivessel coronary artery disease studies

Aggarwal, Vikas; Rajpathak, Swapnil; Singh, Manjeet; Romick, Benjamin; Srinivas, Vankeepuram S.

doi:10.4244/eijv7i9a174

Cited by 36 publications

(24 citation statements)

References 26 publications

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“…However, the retrospective nature of those studies, the small number of patients enrolled, the lack of consensus on CR definition, numerous statistical and methodological issues, and significant differences in patient populations studied has led to conflicting results as to the prognostic importance of CR. Recently, Aggarwal and colleagues showed in a meta-analysis from 9 studies that CR by PCI was associated with a marginally lower rate of death, MI, and need for CABG at a mean follow-up of 29 months, with no difference in repeat PCI, as compared with IR (28). Conversely, the only randomized controlled trial comparing a strategy of culprit vessel revascularization to CR failed to demonstrate superiority of CR compared with IR regarding 30-day and 1-year rate of major outcomes, including mortality (29).…”

Section: Discussionmentioning

confidence: 99%

Quantification and Impact of Untreated Coronary Artery Disease After Percutaneous Coronary Intervention

Généreux

Palmerini

Caixeta

et al. 2012

Journal of the American College of Cardiology

329

111

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Objectives The purpose of this study was to quantify the extent and complexity of residual coronary stenoses following percutaneous coronary intervention (PCI) and to evaluate its impact on adverse ischemic outcomes. Background Incomplete revascularization (IR) after PCI is common, and most studies have suggested that IR is associated with a worse prognosis compared with complete revascularization (CR). However, formal quantification of the extent and complexity of residual atherosclerosis after PCI has not been performed. Methods The baseline Synergy Between PCI With Taxus and Cardiac Surgery (SYNTAX) score (bSS) from 2,686 angiograms from patients with moderate- and high-risk acute coronary syndrome (ACS) undergoing PCI enrolled in the prospective ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial was determined. The SS after PCI was also assessed, generating the “residual” SS (rSS). Patients with rSS >0 were defined as having IR and were stratified by rSS tertiles, and their outcomes were compared to the CR group. Results The bSS was 12.8 ± 6.7, and after PCI the rSS was 5.6 ± 2.2. Following PCI, 1,084 patients (40.4%) had rSS = 0 (CR), 523 (19.5%) had rSS >0 but ≤2, 578 (21.5%) had rSS >2 but ≤8, and 501 patients (18.7%) had rSS >8. Age, insulin-treated diabetes, hypertension, smoking, elevated biomarkers or ST-segment deviation, and lower ejection fraction were more frequent in patients with IR compared with CR. The 30-day and 1-year rates of ischemic events were significantly higher in the IR group compared with the CR group, especially those with high rSS. By multivariable analysis, rSS was a strong independent predictor of all ischemic outcomes at 1 year, including all-cause mortality (hazard ratio: 1.05, 95% confidence interval: 1.02 to 1.09, p = 0.006). Conclusions The rSS is useful to quantify and risk-stratify the degree and complexity of residual stenosis after PCI. Specifically, rSS >8.0 after PCI in patients with moderate- and high-risk ACS is associated with a poor 30-day and 1-year prognosis.

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Section: Discussionmentioning

confidence: 99%

Quantification and Impact of Untreated Coronary Artery Disease After Percutaneous Coronary Intervention

Généreux

Palmerini

Caixeta

et al. 2012

Journal of the American College of Cardiology

329

111

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“…However, it remains to be determined whether complete or incomplete revascularization, non-IRA intervention, and timing of intervention can be improved. Although recent studies have supported complete revascularization in patients, including those with angina,36)37)38) more studies are needed to establish staged PCI in these patients.…”

Section: Real-world Application Of Multivessel Intervention In Patienmentioning

confidence: 99%

Current Status of Coronary Intervention in Patients with ST-Segment Elevation Myocardial Infarction and Multivessel Coronary Artery Disease

et al. 2014

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Primary percutaneous coronary intervention (PCI) is a standard interventional treatment modality for ST-segment elevation myocardial infarction (STEMI). Diagnostic coronary angiogram during PCI reveals multivessel coronary artery disease in about half of patients with STEMI, and it is difficult to make decision on the extent of intervention in these patients. Although revascularization for the infarct-related artery only is still effective for STEMI patients, several studies have reported the efficacy of multivessel revascularization during primary PCI, as well as in a staged PCI procedure. Clinicians should consider clinical aspects such as initial cardiogenic shock and myocardial viability when performing primary multivessel intervention, including the risks and benefits of multivessel revascularization in patients undergoing primary PCI. This review describes the current status of performing multivessel PCI in patients with STEMI and proposes an optimal revascularization strategy based on the previous literature.

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“…In patients with MVD, complete revascularization (CR) with PCI may be associated with better outcomes than incomplete revascularization (IR). A recent meta-analysis [15] of 9 PCI studies (7 with BMS, 1 with DES, and 1 with both) demonstrated that patients undergoing CR compared to IR had significantly lower risk of mortality (RR, 0.82; 95% CI, 0.68 to 0.99; p = 0.05). Also in a large (1400 patients) DES study [16] not included in the meta-analysis [15], patients with IR had a strong tendency toward higher risk of death than those with CR over 5 years (8.8% versus 6.2%; p = 0.057).…”

Section: Contents Lists Available At Sciverse Sciencedirectmentioning

confidence: 94%

Drug-eluting stents increase late mortality compared with coronary artery bypass grafting in triple-vessel disease: A meta-analysis of randomized controlled and risk-adjusted observational studies

Takagi

Yamamoto

Iwata

et al. 2012

International Journal of Cardiology

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Clinical outcomes based on completeness of revascularisation in patients undergoing percutaneous coronary intervention: a meta-analysis of multivessel coronary artery disease studies

Abstract: In patients with multivessel coronary disease, complete revascularisation with PCI may be associated with better outcomes than incomplete revascularisation.

Cited by 36 publications

References 26 publications

Quantification and Impact of Untreated Coronary Artery Disease After Percutaneous Coronary Intervention

Quantification and Impact of Untreated Coronary Artery Disease After Percutaneous Coronary Intervention

Current Status of Coronary Intervention in Patients with ST-Segment Elevation Myocardial Infarction and Multivessel Coronary Artery Disease

Drug-eluting stents increase late mortality compared with coronary artery bypass grafting in triple-vessel disease: A meta-analysis of randomized controlled and risk-adjusted observational studies

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