title: Impact of incomplete revascularization of coronary artery disease on long-term cardiac outcomes. Retrospective comparison of angiographic and myocardial perfusion imaging criteria for completeness.
abstract: Coronary revascularization in patients with coronary artery disease may be guided by coronary angiography (CA) or alternatively by ischemia on stress myocardial perfusion imaging (MPI). Which strategy leads to optimal cardiac outcomes is uncertain.
  
  
  
  We performed a retrospective analysis of 170 patients with MPI ischemia and percutaneous coronary intervention. The primary endpoint was all-cause mortality at a mean follow-up of 47 ± 21 months; the secondary end point was the composite of deaths, nonfatal myocardial infarction, and repeat coronary revascularization (MACE). The coronary revascularization was defined as complete (CCR) or incomplete (ICR) as judged by CA criteria and by MPI ischemia matched with CA criteria.
  
  
  
  Nighty-two patients (54%) had ICR by CA criteria (ICR-CA) and 84 (49%) had ICR by MPI criteria (ICR-MPI). Mortality and MACE were lower in patients with CCR-MPI than with ICR-MPI (P = .048, and P = .025). Survival of patients with CCR-CA and ICR-CA was not different (P = .081). Patients with both ICR-MPI and ICR-CA had the worst survival, whereas patients with CCR-MPI and CCR-CA had the best survival (P = .047). By multivariate analysis, ICR-MPI + ICR-CA was an independent predictor of death (P = .025).
  
  
  
  Patients with ICR by MPI were at higher risk than those with CCR. Patients with both ICR by MPI and CA were at the highest risk, while patients with CCR by both MPI and CA had the best long-term event-free survival.
authors.affiliation: Department of Cardiac Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Bei Lishi Lu, Beijing, 100037, People's Republic of China.
authors.forename: Jiehui
authors.initials: J
authors.lastname: Li
authors.affiliation: Division of Cardiovascular Nuclear Medicine, Department of Radiology and Radiological Science SOM, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Schindler
authors.affiliation: Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People's Republic of China.
authors.forename: Shubin
authors.initials: S
authors.lastname: Qiao
authors.affiliation: Department of Nuclear Medicine, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Bei Lishi Lu, Beijing, 100037, People's Republic of China.
authors.forename: Hongxing
authors.initials: H
authors.lastname: Wei
authors.affiliation: Department of Nuclear Medicine, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Bei Lishi Lu, Beijing, 100037, People's Republic of China.
authors.forename: Yueqin
authors.initials: Y
authors.lastname: Tian
authors.affiliation: Department of Nuclear Medicine, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Bei Lishi Lu, Beijing, 100037, People's Republic of China.
authors.forename: Weixue
authors.initials: W
authors.lastname: Wang
authors.affiliation: Department of Nuclear Medicine, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Bei Lishi Lu, Beijing, 100037, People's Republic of China. articlesubmisson@qq.com.
authors.forename: Xiaoli
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Department of Cardiac Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Bei Lishi Lu, Beijing, 100037, People's Republic of China. xiubinyang@yahoo.com.
authors.forename: Xiubin
authors.initials: X
authors.lastname: Yang
authors.affiliation: Department of Nuclear Medicine, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Bei Lishi Lu, Beijing, 100037, People's Republic of China.
authors.forename: Xiujie
authors.initials: X
authors.lastname: Liu
mesh_terms: D002681:China / Q000453:epidemiology; D017023:Coronary Angiography / Q000379:methods* / Q000706:statistics & numerical data; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods* / Q000706:statistics & numerical data; D009204:Myocardial Revascularization / Q000401:mortality* / Q000706:statistics & numerical data*; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D017211:Treatment Failure
keywords: Coronary artery disease; coronary angiography; incomplete revascularization; myocardial perfusion imaging; percutaneous coronary intervention