title: Outcomes after complete versus incomplete revascularization of patients with multivessel coronary artery disease: a meta-analysis of 89,883 patients enrolled in randomized clinical trials and observational studies.
abstract: OBJECTIVE
  This study sought to perform a systematic review and meta-analysis of studies comparing complete revascularization (CR) versus incomplete revascularization (IR) in patients with multivessel coronary artery disease.
  
  
  BACKGROUND
  There are conflicting data regarding the benefits of CR in patients with multivessel coronary artery disease.
  
  
  METHODS
  We identified observational studies and subgroup analysis of randomized clinical trials (RCT) published in PubMed from 1970 through September 2012 using the following keywords: "percutaneous coronary intervention" (PCI); "coronary artery bypass graft" (CABG); "complete revascularization"; and "incomplete revascularization." Main outcome measures were total mortality, myocardial infarction, and repeat revascularization procedures.
  
  
  RESULTS
  We identified 35 studies including 89,883 patients, of whom 45,417 (50.5%) received CR and 44,466 (49.5%) received IR. IR was more common after PCI than after CABG (56% vs. 25%; p < 0.001). Relative to IR, CR was associated with lower long-term mortality (risk ratio [RR]: 0.71, 95% confidence interval [CI]: 0.65 to 0.77; p < 0.001), myocardial infarction (RR: 0.78, 95% CI: 0.68 to 0.90; p = 0.001), and repeat coronary revascularization (RR: 0.74, 95% CI: 0.65 to 0.83; p < 0.001). The mortality benefit associated with CR was consistent across studies irrespective of revascularization modality (CABG: RR: 0.70, 95% CI: 0.61 to 0.80; p < 0.001; and PCI: RR: 0.72, 95% CI: 0.64 to 0.81; p < 0.001) and definition of CR (anatomic definition: RR: 0.73, 95% CI: 0.67 to 0.79; p < 0.001; and nonanatomic definition: RR: 0.57, 95% CI: 0.36 to 0.89; p = 0.014).
  
  
  CONCLUSIONS
  CR is achieved more commonly with CABG than with PCI. Among patients with multivessel coronary artery disease, CR may be the optimal revascularization strategy.
authors.affiliation: Division of Cardiology, Department of Medicine, Minneapolis Veterans Affairs Healthcare System, Minneapolis, Minnesota; Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota. Electronic address: garci205@umn.edu.
authors.forename: Santiago
authors.initials: S
authors.lastname: Garcia
authors.forename: Yader
authors.initials: Y
authors.lastname: Sandoval
authors.forename: Henri
authors.initials: H
authors.lastname: Roukoz
authors.forename: Selcuk
authors.initials: S
authors.lastname: Adabag
authors.forename: Mariana
authors.initials: M
authors.lastname: Canoniero
authors.forename: Demetris
authors.initials: D
authors.lastname: Yannopoulos
authors.forename: Emmanouil S
authors.initials: ES
authors.lastname: Brilakis
mesh_terms: D057186:Comparative Effectiveness Research; D016001:Confidence Intervals; D003324:Coronary Artery Disease / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D003331:Coronary Vessels / Q000473:pathology / Q000601:surgery; D006801:Humans; D009204:Myocardial Revascularization / Q000145:classification / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data; D064887:Observational Studies as Topic; D017063:Outcome Assessment, Health Care; D016032:Randomized Controlled Trials as Topic; D012086:Reoperation / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: CABG; CAD; CI; CR; CTO; FFR; IR; MI; OR; PCI; RCT; RR; chronic total occlusion; complete revascularization; confidence interval; coronary artery bypass graft; coronary artery bypass surgery; coronary artery disease; fractional-flow reserve; incomplete revascularization; meta-analysis; myocardial infarction; odds ratio; percutaneous coronary intervention; randomized clinical trial; risk ratio