title: Long-term outcomes of complete versus incomplete revascularization after drug-eluting stent implantation in patients with multivessel coronary disease.
abstract: BACKGROUND
  A limited number of studies on the impact of complete revascularization (CR) vs. incomplete revascularization (IR) on long-term outcomes in patients with multivessel coronary disease (MVD) in current percutaneous coronary intervention (PCI) practice have yielded inconsistent results.
  
  
  METHODS
  Between April 2004 and November 2010, 7,376 consecutive patients with MVD underwent PCI at the Fuwai Hospital in Beijing, China. Patients who underwent prior CABG and those who had an acute myocardial infarction (MI) within 24 hr before revascularization or presented with cardiogenic shock were excluded. Angiographic CR was defined as successful angioplasty of all diseased lesions in the major epicardial coronary vessels and their first degree side branches (diameter ≥2.5 mm), and proximal CR was defined as successful angioplasty of all diseased proximal arteries.
  
  
  RESULTS
  Among 7,065 patients with MVD undergoing PCI treatment, angiographic CR was performed in 1,188 patients (16.8%), and proximal CR in 2,053 patients (29.1%). The study found that either angiographic or proximal IR were associated with significantly higher estimated 3-year rate of cardiac death (2.55% vs. 1.13%, log-rank P = 0.016; and 2.70% vs. 1.43%, log-rank P = 0.024, respectively). After adjustment for differences in baseline characteristics between IR and CR patients, angiographic IR was associated with a significantly higher rate of cardiac death (adjusted hazards ratio [HR]: 2.56, 95% confidence interval [CI]: 1.03-6.41) while proximal IR was associated with a numerically higher rate of cardiac death (adjusted HR: 1.72, 95% CI: 0.93-3.17). For the subgroup of ≥2-vessel IR with total occlusion, either angiographic or proximal IR patients had significantly higher rate of cardiac death (adjusted HR: 4.25, 95% CI: 1.50-12.09; and adjusted HR: 3.02, 95% CI: 1.40-6.52, respectively).
  
  
  CONCLUSIONS
  Compared with IR, patients with CR had better clinical outcomes, supporting CR as first choice for patients with MVD.
authors.affiliation: Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
authors.forename: Zhan
authors.initials: Z
authors.lastname: Gao
authors.forename: Bo
authors.initials: B
authors.lastname: Xu
authors.forename: Yue-Jin
authors.initials: YJ
authors.lastname: Yang
authors.forename: Jin-Qing
authors.initials: JQ
authors.lastname: Yuan
authors.forename: Jue
authors.initials: J
authors.lastname: Chen
authors.forename: Ji-Lin
authors.initials: JL
authors.lastname: Chen
authors.forename: Shu-Bin
authors.initials: SB
authors.lastname: Qiao
authors.forename: Yong-Jian
authors.initials: YJ
authors.lastname: Wu
authors.forename: Hong-Bin
authors.initials: HB
authors.lastname: Yan
authors.forename: Run-Lin
authors.initials: RL
authors.lastname: Gao
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D002681:China; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
keywords: complete revascularization; incomplete revascularization; multivessel coronary disease; percutaneous coronary intervention