Complete revascularization in patients undergoing multivessel PCI is an independent predictor of improved long-term survival.
BACKGROUND
The prognostic relevance of complete revascularization (CR) in patients with multivessel coronary artery disease (MV-CAD) has been established so far for surgical treatment strategies rather than for percutaneous coronary revascularization (PCI). In addition, different definitions of CR have further complicated the interpretation of clinical studies.


METHODS
Procedural characteristics and long-term overall survival were assessed in 679 consecutive "all-comer" patients, who underwent PCI in at least two main vessels. We adapted three definitions of CR from the coronary artery bypass grafting (CABG) trials. CR was achieved if following MV-PCI one of the three criteria was met: (1) no residual stenosis in a main coronary vessel, (2) no residual stenosis in any coronary segment, or (3) no residual stenosis in the left anterior descending (LAD) and at least one further main branch. The main objective was the evaluation of predictors of incomplete revascularization and the prognostic impact of CR in MV-PCI patients.


RESULTS
CR was achieved in 76%, 67%, and 95%, respectively, (definitions 1-3). Patients without CR were older, had a lower ejection fraction, and presented more often with acute coronary syndromes (ACS). Clinical long-term follow-up regarding survival was available in 664 patients (98%) with a mean follow-up of 2.5 +/- 1.6 years. Independent of the specific definition, CR was associated with a reduced long-term mortality by approximately 50%. After adjusting for relevant baseline parameters, only absence of residual stenosis in all coronary segments remained as an independent predictor of long-term prognosis (hazard ratio [HR]= 0.51, 95% confidence interval [CI]: 0.28-0.93; P = 0.025).


CONCLUSIONS
CR of all coronary segments is associated with improved overall survival after MV-PCI.
Lehmann
Ralf
R
Department of Cardiology, Goethe-University Frankfurt, Frankfurt, Germany.
Fichtlscherer
Stephan
S
Schächinger
Volker
V
Held
Laura
L
Hobler
Carola
C
Baier
Gregor
G
Zeiher
Andreas M
AM
Spyridopoulos
Ioakim
I
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data*; D002097:C-Reactive Protein; D016001:Confidence Intervals; D003324:Coronary Artery Disease / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D023903:Coronary Restenosis / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D018450:Disease Progression; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom; D016277:Ventricular Function, Left
D002097:C-Reactive Protein