Complete versus culprit vessel percutaneous coronary intervention in multivessel disease: a randomized comparison.
BACKGROUND
The purpose of this study was to compare the safety, efficacy, and costs of complete versus "culprit" vessel revascularization in multivessel coronary artery disease treated with percutaneous coronary interventions (PCI).


METHODS
Patients with multivessel disease and an identified culprit vessel were randomly assigned to complete revascularization of vessels > or =50% stenoses (n = 108) versus revascularization limited to the culprit vessel (n = 111). The primary end point, major adverse cardiac events (MACE), were defined as cardiac or noncardiac death, myocardial infarction, need for coronary artery bypass graft surgery, and repeat PCI up to 1 year.


RESULTS
Despite equal MACE at 24 hours (6.3% vs 7.4%), strategy success was higher in the culprit vessel than in the complete revascularization group (93.7% vs 81.5%, P =.007). MACE rates at 1 month (14.4% vs 9.3%), 1 year (32.4% vs 26.9%), and 4.6 +/- 1.2 years (40.4% vs 34.6%) were similar in both groups. Repeat PCI was performed more often in the culprit vessel group (31.2% vs 21.2%, P =.06). A lower consumption of medical material was associated with lower procedural costs in the culprit vessel group (5784 vs 7315 Euros; P <.001). However, between 1 year and the end of follow-up, costs had equalized in both groups.


CONCLUSIONS
Complete versus culprit vessel revascularization in multivessel coronary disease treated with PCI was associated with a lower strategy success rate, similar MACE rates, and initially higher costs. However, over the long term, more repeat PCIs were conducted in patients treated by culprit revascularization only, mostly because of the need to treat lesions initially left untreated. As a consequence, incremental costs had equalized within 1 year. The decision of whether to perform culprit vessel or complete revascularization can be made on an individual basis.
Ijsselmuiden
Alexander J J
AJ
Amsterdam Department of Interventional Cardiology OLVG Hospital, Amsterdam, The Netherlands. a.j.j.ijsselmuiden@olvg.nl
Ezechiels
JanPaul
J
Westendorp
Iris C D
IC
Tijssen
Jan G P
JG
Kiemeneij
Ferdinand
F
Slagboom
Ton
T
van der Wieken
Ron
R
Tangelder
GeertJan
G
Serruys
Patrick W
PW
Laarman
GertJan
G
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000191:economics / Q000379:methods*; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000401:mortality / Q000628:therapy*; D004180:Direct Service Costs; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction; D011446:Prospective Studies; D015607:Stents; D016896:Treatment Outcome