title: Completeness of revascularization and its impact on the outcomes of a staged approach of percutaneous coronary intervention followed by minimally invasive valve surgery for patients with concomitant coronary artery and valvular heart disease.
abstract: BACKGROUND
  A staged approach of percutaneous coronary intervention (PCI) followed by minimally invasive valve surgery (MIVS) is an alternative to the conventional combined coronary artery bypass and valve surgery for patients with concomitant coronary artery and valve disease. Limited data exist on degree of the completeness of revascularization achieved with this approach and its impact on outcomes.
  
  
  METHODS
  A total of 138 patients, who underwent a staged approach between January 2009 and June 2013, were retrospectively evaluated. Coronary angiograms were reviewed by two cardiologists blinded to outcomes and were then categorized into two groups: complete or incomplete revascularization, which was defined as ≥1 major epicardial coronary arteries of at least 2.0 mm diameter with ≥70% untreated obstruction after the index PCI and before MIVS.
  
  
  RESULTS
  Complete and incomplete revascularization was achieved in 105 (76%) and 33 (24%) patients, respectively. The patients with incomplete revascularization had a lower ejection fraction, a higher STS score, and more prior myocardial infarctions and multi-vessel coronary artery disease. There were no differences in the post-operative complications, 30-day mortality, or 3-year survival (84 vs. 83%, P = 0.68). After a median follow-up of 29 months, incompletely revascularized patients had a higher incidence of acute coronary syndrome (2.9 vs. 12.9%, P = 0.05).
  
  
  CONCLUSIONS
  In patients undergoing a staged approach of PCI followed by MIVS, incomplete revascularization did not significantly impact the short or mid-term survival, but was associated with an increased incidence of acute coronary syndrome at follow-up. © 2015 Wiley Periodicals, Inc.
authors.affiliation: Columbia University Division of Cardiology at the Mount Sinai Heart Institute, Miami Beach, Florida.
authors.forename: Andrés M
authors.initials: AM
authors.lastname: Pineda
authors.affiliation: Columbia University Division of Cardiology at the Mount Sinai Heart Institute, Miami Beach, Florida.
authors.forename: Ramesh
authors.initials: R
authors.lastname: Chandra
authors.affiliation: Columbia University Division of Cardiology at the Mount Sinai Heart Institute, Miami Beach, Florida.
authors.forename: Saqib A
authors.initials: SA
authors.lastname: Gowani
authors.affiliation: Columbia University Division of Cardiology at the Mount Sinai Heart Institute, Miami Beach, Florida.
authors.forename: Orlando
authors.initials: O
authors.lastname: Santana
authors.affiliation: Columbia University Division of Cardiology at the Mount Sinai Heart Institute, Miami Beach, Florida.
authors.forename: Christos G
authors.initials: CG
authors.lastname: Mihos
authors.affiliation: Columbia University Medical Center, New York, New York.
authors.forename: Ajay J
authors.initials: AJ
authors.lastname: Kirtane
authors.affiliation: Columbia University Medical Center, New York, New York.
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
authors.affiliation: Columbia University Medical Center, New York, New York.
authors.forename: Paul
authors.initials: P
authors.lastname: Kurlansky
authors.affiliation: Columbia University Medical Center, New York, New York.
authors.forename: Craig R
authors.initials: CR
authors.lastname: Smith
authors.affiliation: Columbia University Division of Cardiology at the Mount Sinai Heart Institute, Miami Beach, Florida. nirat.beohar@msmc.com.
authors.forename: Nirat
authors.initials: N
authors.lastname: Beohar
mesh_terms: D054058:Acute Coronary Syndrome / Q000209:etiology; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D023921:Coronary Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D009203:Myocardial Infarction / Q000209:etiology; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
keywords: coronary artery disease; minimally invasive surgery; percutaneous coronary intervention; revascularization; staged approach; valve disease