Complete or incomplete percutaneous coronary revascularization in patients with unstable angina in stent era: Are early and one‐year results different?

Abstract

The aim of our study was to evaluate the impact of a strategy of incomplete revascularization by PTCA, with or without stent implantation, on clinical outcome of 208 consecutive patients (171 men) with unstable angina and multivessel coronary artery disease. Mean age of the group was 63.8 +/- 10.3 years (range, 31-91). Complete and incomplete revascularization was achieved in 49 and 159 patients, respectively. A total of 226 stents were implanted in 172 patients (1.31 +/- 0.65 stent per patient), equally distributed between the two groups. Left ventricular ejection fraction < 40% and total chronic coronary occlusions were significantly more frequent in patients with incomplete revascularization than in those with complete (P = 0.014 and 0.001, respectively). In-hospital MACE occurred in 10% and 7.5% of patients with complete and incomplete revascularization, respectively (P = NS). By multivariate analysis, multiple stent implantation (OR, 5.44; 95% CI, 1.21-24.3), presence of thrombus in the treated lesion (OR, 6.3; 95% CI, 1.53-25.9), Braunwald class III (OR, 4.74; 95% CI, 1.08-20.8), and ad hoc PTCA (OR 4.51; 95% CI, 1.11-18.3) were significantly related to in-hospital outcome. At 1-year follow-up, 11.3% and 11.5% of patients with complete and incomplete revascularization, respectively, had MACE. In all patients, diabetes (OR, 3.40; 95% CI, 1.09-10.58) and presence of thrombus in the treated lesion (OR, 3.48; 95% CI, 1.12-10.84) were significant predictors of 1-year outcome by multivariate analysis. These results indicate that the strategy of incomplete revascularization in unstable angina patients with multivessel coronary disease does not expose them to a higher risk of death or other major ischemic events in comparison to those undergoing complete revascularization.

Impact of Completeness of Percutaneous Coronary Intervention Revascularization on Long-Term Outcomes in the Stent Era

“…However, the study had low statistical power, with only 44 CR patients and 147 IR patients. 6 In a study of diabetic patients with multivessel disease who underwent PCI, Nikolsky et al 10 found that IR patients had a significantly lower 5-year survival rate (83.0% versus 94.5%; PϽ0.001) and a significantly lower myocardial infarction-free survival rate (79.9% versus 92.9%). In addition, after adjustment for patient risk, IR was significantly related to higher mortality (95% CI for HRϭ1.54 to 7.69; Pϭ0.003).…”

Long-Term Outcomes of Intervention for Unprotected Left Main Coronary Artery Stenosis Coronary Stenting vs Coronary Artery Bypass Grafting

“…25,26 Acute MI patients undergoing primary PCI also have a more favorable outcome if complete revascularization is achieved before discharge, 27 but incomplete revascularization does not expose patients with unstable angina to a higher risk. 28 The Arterial Revascularization Therapies Study (ARTS) revealed a lower incidence of death, MI, and stroke in the complete revascularization group by CABG than in patients undergoing in incomplete revascularization by PCI. 29 The major advantage of complete revascularization by CABG is avoidance of future revascularizations in the follow-up period, but this advantage in the CABG group is neutralized if DES are implanted in the PCI group.…”

Incomplete Revascularization in the Era of Drug-Eluting Stents

“…Although multiple studies (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17) have compared outcomes of patients who have been completely and incompletely revascularized with PCI, few of these are recent.…”