TY - JOUR
T1 - Incidence, predictors and outcomes of incomplete revascularization after percutaneous coronary intervention and coronary artery bypass grafting
T2 - A subgroup analysis of 3-year SYNTAX data
AU - Head, Stuart J.
AU - Mack, Michael J.
AU - Holmes, David R.
AU - Mohr, Friedrich W.
AU - Morice, Marie Claude
AU - Serruys, Patrick W.
AU - Kappetein, A. Pieter
N1 - Funding Information:
This research was supported by Boston Scientific Corp.
PY - 2012/3/1
Y1 - 2012/3/1
N2 - Objective: To assess whether incomplete revascularization by percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) has an effect on long-term outcomes. Methods: During a heart team discussion to evaluate whether patients were eligible for randomization in the SYNTAX trial, both the cardiologist and surgeon agreed on which vessels needed revascularization. This statement was compared with the actual revascularization after treatment. Incomplete revascularization was defined as when a preoperatively identified vessel with a lesion was not revascularized. Outcomes were major adverse cardiac or cerebrovascular events (MACCE), the composite safety endpoint of death/ stroke/myocardial infarction (MI), and individual MACCE components death, MI and repeat revascularization at 3 years. Predictors of incomplete revascularization were explored. Results: Incomplete revascularization was found in 43.3% (388/896) PCI and 36.8% (320/870) CABG patients. Patients with complete revascularization by PCI had lower rates of MACCE (66.5 versus 76.2%, P<0.001), the composite safety endpoint (83.4 versus 87.9%,P=0.05) and repeat revascularization (75.5 versus 83.9%, P<0.001), but not death and MI. In the CABG group, no difference in outcomes was seen between incomplete and complete revascularization groups. Incomplete revascularization was identified as independent predictor of MACCE in PCI (HR=1.55, 95% CI 1.15-2.08,P=0.004) but not CABG patients. Independent predictors of incomplete revascularization by PCI were hyperlipidaemia (OR=1.59, 95% CI 1.04-2.42, P=0.031), a total occlusion (OR=2.46, 95% CI 1.66-3.64, P< 0.001) and the number of vessels (OR =1.58, 95% CI 1.41-1.77, P< 0.001). Independent predictors of incomplete revascularization by CABG were unstable angina (OR =1.42, 95% CI 1.02-1.98,P=0.038), diffuse disease or narrowed (<2 mm) segment distal to the lesion (OR=1.87, 95% CI 1.31-2.69,P =0.001) and the number of vessels (OR =1.70, 95% CI 1.53-1.89, P < 0.001). Conclusions: Despite the hypothesis-generating nature of this data, this study demonstrates that incomplete revascularization is associated with adverse events during follow-up after PCI but not CABG.
AB - Objective: To assess whether incomplete revascularization by percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) has an effect on long-term outcomes. Methods: During a heart team discussion to evaluate whether patients were eligible for randomization in the SYNTAX trial, both the cardiologist and surgeon agreed on which vessels needed revascularization. This statement was compared with the actual revascularization after treatment. Incomplete revascularization was defined as when a preoperatively identified vessel with a lesion was not revascularized. Outcomes were major adverse cardiac or cerebrovascular events (MACCE), the composite safety endpoint of death/ stroke/myocardial infarction (MI), and individual MACCE components death, MI and repeat revascularization at 3 years. Predictors of incomplete revascularization were explored. Results: Incomplete revascularization was found in 43.3% (388/896) PCI and 36.8% (320/870) CABG patients. Patients with complete revascularization by PCI had lower rates of MACCE (66.5 versus 76.2%, P<0.001), the composite safety endpoint (83.4 versus 87.9%,P=0.05) and repeat revascularization (75.5 versus 83.9%, P<0.001), but not death and MI. In the CABG group, no difference in outcomes was seen between incomplete and complete revascularization groups. Incomplete revascularization was identified as independent predictor of MACCE in PCI (HR=1.55, 95% CI 1.15-2.08,P=0.004) but not CABG patients. Independent predictors of incomplete revascularization by PCI were hyperlipidaemia (OR=1.59, 95% CI 1.04-2.42, P=0.031), a total occlusion (OR=2.46, 95% CI 1.66-3.64, P< 0.001) and the number of vessels (OR =1.58, 95% CI 1.41-1.77, P< 0.001). Independent predictors of incomplete revascularization by CABG were unstable angina (OR =1.42, 95% CI 1.02-1.98,P=0.038), diffuse disease or narrowed (<2 mm) segment distal to the lesion (OR=1.87, 95% CI 1.31-2.69,P =0.001) and the number of vessels (OR =1.70, 95% CI 1.53-1.89, P < 0.001). Conclusions: Despite the hypothesis-generating nature of this data, this study demonstrates that incomplete revascularization is associated with adverse events during follow-up after PCI but not CABG.
KW - Completeness
KW - Coronary artery bypass grafting
KW - Myocardial revascularization
KW - Outcomes
KW - Percutaneous coronary intervention
KW - SYNTAX
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U2 - 10.1093/ejcts/ezr105
DO - 10.1093/ejcts/ezr105
M3 - Article
C2 - 22219412
AN - SCOPUS:84861453872
SN - 1010-7940
VL - 41
SP - 535
EP - 541
JO - European Journal of Cardio-thoracic Surgery
JF - European Journal of Cardio-thoracic Surgery
IS - 3
ER -