title: Complete myocardial revascularization confers a larger clinical benefit when performed with state-of-the-art techniques in high-risk patients with multivessel coronary artery disease: A meta-analysis of randomized and observational studies.
abstract: OBJECTIVE
  To test whether a strategy of complete revascularization (CR) as compared with incomplete myocardial revascularization (IR)-both performed with current "state-of-the-art" percutaneous coronary interventions (PCI) or coronary artery bypass graft (CABG)-would provide a clinical benefit in patients with multivessel coronary artery disease (MVCAD).
  
  
  BACKGROUND
  The "optimal" extent of myocardial revascularization remains to be determined.
  
  
  METHODS
  We performed a meta-analysis of studies reporting on clinical outcomes of MVCAD patients treated with CR and IR, with extensive (>80%) use of stents for PCI or arterial conduits in CABG. Relative risk (RR) and 95% confidence intervals (CIs) for all-cause mortality were assessed as primary endpoint, myocardial infarction (MI) and repeat revascularization as secondary endpoints.
  
  
  RESULTS
  A total of 28 studies were identified, including 83,695 patients with 4.7 ± 4.3 years of follow-up. Compared with IR, CR was associated with reduced mortality (RR: 0.73; 95% CI 0.66-0.81) both after CABG (RR: 0.76; 95% CI 0.63-0.90) and PCI (RR: 0.73; 95% CI 0.64-0.82). The risks of MI (RR: 0.74; 95% CI 0.64-0.85) and repeat revascularization (RR: 0.77; 95% CI 0.66-0.88) were also lower after CR as compared with IR. Metaregression showed a significant RR reduction of MI associated with more recent publication (P = 0.021) and increasing prevalence of diabetes (P = 0.033).
  
  
  CONCLUSIONS
  In MVCAD, as compared with IR, CR confers a clinical benefit that seems larger in cohorts of patients enrolled in more recent studies and with a higher prevalence of diabetes. © 2015 Wiley Periodicals, Inc.
authors.affiliation: Institute of Cardiology and Center of Excellence on Aging, "G, d'Annunzio" University, Chieti, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Zimarino
authors.affiliation: Institute of Cardiology and Center of Excellence on Aging, "G, d'Annunzio" University, Chieti, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Ricci
authors.affiliation: Institute of Cardiology and Center of Excellence on Aging, "G, d'Annunzio" University, Chieti, Italy.
authors.forename: Mattia
authors.initials: M
authors.lastname: Romanello
authors.affiliation: Laboratory of Biostatistics, Department of Experimental and Clinical Science, "G, d'Annunzio" University, Chieti, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Di Nicola
authors.affiliation: Institute of Cardiology and Center of Excellence on Aging, "G, d'Annunzio" University, Chieti, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Corazzini
authors.affiliation: Institute of Cardiology and Center of Excellence on Aging, "G, d'Annunzio" University, Chieti, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: De Caterina
mesh_terms: D003324:Coronary Artery Disease / Q000601:surgery*; D006801:Humans; D009204:Myocardial Revascularization / Q000592:standards*; D064887:Observational Studies as Topic; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic
keywords: coronary artery bypass graft; coronary artery disease; percutaneous coronary intervention