Impact of Angiographic Complete Revascularization After Drug-Eluting Stent Implantation or Coronary Artery Bypass Graft Surgery for Multivessel Coronary Artery Disease

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.

Impact of Ischemia-Guided Revascularization With Myocardial Perfusion Imaging for Patients With Multivessel Coronary Disease

“…The study population was a part of the Asan Multivessel Registry and included consecutive patients with MVD who underwent PCI with DES or CABG ( Fig. 1) (2). Patients who presented with ST-segment elevation MI and/or cardiogenic shock or for whom no clinical follow-up information was available were excluded.…”

“…Patients who presented with ST-segment elevation MI and/or cardiogenic shock or for whom no clinical follow-up information was available were excluded. The procedures and follow-up have been described previously (2). During the study period, DES was the default stent for PCI in patients with MVD.…”

“…In the absence of disabling symptoms, evidence of ischemia has been recognized as critical in deciding whether to proceed with revascularization. Without objective determination of ischemia, complete angiographic revascularization might not be superior to reasonable incomplete revascularization (1,2). Myocardial perfusion imaging (MPI) with stress single-photon emission computed tomography (SPECT) has been used to diagnose inducible ischemia and to predict prognosis of patients with coronary artery disease, and SPECT results have shown fair concordance with the prevalence of significant ischemia (3).…”

Relationship Between Residual Syntax Score and In Hospital Outcomes In Patients Undergoing Primary Percutaneous Intervention

“…PKG'deki büyük teknik gelişmelere rağmen, komplet revaskülarizasyonun elde edilmesi hâlen çok sık değil-dir. PKG sonrası inkomplet revaskülarizasyonun (İR) prognostik etkisi çalışmalar arasında tutarsızdır [4][5][6] . Evrensel olarak kabul edilmiş bir inkomplet revaskülarizasyon tanımlaması yoktur ve PKG sonrası rezidüel koroner darlıkların ciddiyeti, derecesi ve niteliğinin hasta sonlanımlarında farklı etkilere sahip olduğu söylenilebilir.…”

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

“…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). In PCI with DES compared to CABG, more frequent IR may explain higher mortality demonstrated in our meta-analysis.…”