title: Functionally driven complete vs incomplete revascularisation in multivessel coronary artery disease--long-term results from a large cohort.
abstract: BACKGROUND
  Complete revascularisation (CR) by means of percutaneous coronary intervention (PCI) has been associated with better long-term prognosis than incomplete revascularisation (IR) in several clinical trials. However, in the published studies, the completeness of myocardial revascularisation has been judged mainly on an anatomical basis, while including criteria directed at functionally driven IR might lead to different results.
  
  
  OBJECTIVE
  To examine the potential value of functionally driven IR in a large cohort of patients with multivessel coronary artery disease (MVD) undergoing PCI.
  
  
  METHODS
  The study population consisted of 908 patients with MVD undergoing PCI without stenting between 1988 and 1997. Functionally driven IR was defined as dilation of all segments with >70% stenosis, with the exception of arteries supplying an area of previous transmural myocardial infarction (MI) or a small amount of myocardium. Complete revascularisation was defined as successful PCI of all coronary artery lesions with significant narrowing not fulfilling the above criteria. Patients were followed for a mean 11 years (range 8-16 years). End-points included: death, MI, re-PCI or coronary artery bypass grafting (CABG).
  
  
  RESULTS
  Complete revascularisation was performed in 284 (31.3%) patients. Follow-up was obtained from 873 (96.1%) patients. There was no significant difference in the frequency of all-cause mortality, cardiovascular deaths or MI between patients who underwent CR and IR. Patients who underwent IR were more likely to require re-PCI and had a trend toward more frequent CABG.
  
  
  CONCLUSIONS
  In comparison to CR, a strategy of functionally driven IR by means of PCI without stenting does not increase the rate of major cardiovascular outcomes, but is related to higher frequency of repeat procedures during a long-term follow-up.
authors.affiliation: Department of Coronary Artery Disease and Structural Heart Diseases, Institute of Cardiology, Warsaw, Poland. botto@ikard.pl
authors.forename: Bożena
authors.initials: B
authors.lastname: Norwa-Otto
authors.forename: Jacek
authors.initials: J
authors.lastname: Kądziela
authors.forename: Lukasz A
authors.initials: LA
authors.lastname: Małek
authors.forename: Artur
authors.initials: A
authors.lastname: Dębski
authors.forename: Adam
authors.initials: A
authors.lastname: Witkowski
authors.forename: Marcin
authors.initials: M
authors.lastname: Demkow
authors.forename: Witold
authors.initials: W
authors.lastname: Rużyłło
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000628:therapy*; D003331:Coronary Vessels / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D016896:Treatment Outcome