Impact of Incomplete Percutaneous Revascularization in Patients With Multivessel Coronary Artery Disease: A Systematic Review and Meta‐Analysis

Abstract

BackgroundUp to half of patients undergoing percutaneous coronary intervention have multivessel coronary artery disease (MVD) with conflicting data regarding optimal revascularization strategy in such patients. This paper assesses the evidence for complete revascularization (CR) versus incomplete revascularization in patients undergoing percutaneous coronary intervention, and its prognostic impact using meta‐analysis.Methods and ResultsA search of PubMed, EMBASE, MEDLINE, Current Contents Connect, Google Scholar, Cochrane library, Science Direct, and Web of Science was conducted to identify the association of CR in patients with multivessel coronary artery disease undergoing percutaneous coronary intervention with major adverse cardiac events and mortality. Random‐effects meta‐analysis was used to estimate the odds of adverse outcomes. Meta‐regression analysis was conducted to assess the relationship with continuous variables and outcomes. Thirty‐eight publications that included 156 240 patients were identified. Odds of death (OR 0.69, 95% CI 0.61‐0.78), repeat revascularization (OR 0.60, 95% CI 0.45‐0.80), myocardial infarction (OR 0.64, 95% CI 0.50‐0.81), and major adverse cardiac events (OR 0.63, 95% CI 0.50‐0.79) were significantly lower in the patients who underwent CR. These outcomes were unchanged on subgroup analysis regardless of the definition of CR. Similar findings were recorded when CR was studied in the chronic total occlusion (CTO) subgroup (OR 0.65, 95% CI 0.53‐0.80). A meta‐regression analysis revealed a negative relationship between the OR for mortality and the percentage of CR.Conclusion CR is associated with reduced risk of mortality and major adverse cardiac events, irrespective of whether an anatomical or a score‐based definition of incomplete revascularization is used, and this magnitude of risk relates to degree of CR. These results have important implications for the interventional management of patients with multivessel coronary artery disease.

Complete versus incomplete revascularization with drug‐eluting stents for multi‐vessel disease in stable, unstable angina or non‐ST‐segment elevation myocardial infarction: A meta‐analysis

“…In CR strategy, there is a high likelihood that the number and length of the implanted stents will increase and therefore, higher risk of restenosis. DES was associated with decreased restenosis and lower target revascularization . Our study supports similar favorable clinical outcomes in DES PCI in MVD when CR is achieved; however, although mortality and adverse events were lower in CR, repeat revascularization was still higher in IR even when PCI was performed with DES.…”

“…They reported similar outcomes to study by Garcia et al, favoring CR in both PCI and coronary artery bypass graft; however, they did not distinguish results between BMS and DES . Most recently, Nagaraja et al published a meta‐analysis of CR versus IR in MVD without STEMI with both DES and BMS. According to their report, CR was achieved in mean of 42.7% and it was associated with decreased risk of all‐cause mortality (OR 0.69 95%CI 0.61–0.78).…”

“…The benefit of CR was maintained for MACE and repeat revascularization. However, patients who presented with acute coronary syndromes did not benefit from CR . Moreover, sub‐group analysis based on stent type (DES or BMS) was not reported in these studies …”

“…25 who presented with acute coronary syndromes did not benefit from CR. 26 Moreover, sub-group analysis based on stent type (DES or BMS) was not reported in these studies. 5,25,26 Our results with DES exclusive PCI were generally in agreements with these publications.…”

Outcomes of myocardial revascularization in patients with severe CHF of ischemic origin

“…Известно, что анатомическая полнота восстановления коронарного русла у пациентов с ХСН III-IV ФК не оказывала влия-ния на динамику функционального состояния миокар-да в результате коронарной ангиопластики [9]. Данное обстоятельство не согласуется с известными результата-ми, показавшими преимущества полной реваскуляриза-ции коронарного русла у больных с хроническими форма-ми ИБС [10]. Однако в этих сравнениях число пациентов с клинически значимой ХСН и выраженным снижени-ем систолической функции ЛЖ было незначительным.…”