title: Incidence and predictors of incomplete revascularization in a contemporary cohort.
abstract: OBJECTIVE
  Complete coronary revascularization has been associated with improved mortality among patients undergoing surgical bypass grafting. A similar evaluation among patients undergoing percutaneous coronary intervention (PCI) for multivessel disease has produced largely concordant results, although complete percutaneous revascularization is often not achieved in this population. The present study sought to evaluate the clinical and anatomic limitations to complete revascularization among contemporary patients undergoing percutaneous revascularization for multivessel coronary artery disease.
  
  
  METHODS
  All patients undergoing nonemergent PCI for unprotected left main or multivessel coronary artery disease were identified at two academic medical centers from 2009 to 2012. Complete revascularization was determined through a review of the electronic medical records and corresponding coronary angiograms. The underlying reasons that precluded complete revascularization were then derived from a review of the clinical and angiographic findings.
  
  
  RESULTS
  Among 978 patients with multivessel coronary artery disease, 267 (27%) underwent complete percutaneous coronary revascularization. Factors that prevented complete revascularization included chronic total occlusions (54%), treatment limited to the culprit lesion (24%), or persistent disease in small nondominant vessels (24%). After multivariable adjustment, the presence of a chronic total occlusion was associated with significantly reduced odds of receiving complete revascularization (adjusted odds ratio: 0.18, 95% confidence interval: 0.12-0.27).
  
  
  CONCLUSIONS
  Complete percutaneous revascularization is uncommon and is hindered by the presence of chronic total occlusions or isolated treatment of an angiographic culprit lesion. Evolving interventional techniques enabling treatment of chronic total occlusions may increase the prevalence of complete percutaneous revascularization in the future.
authors.affiliation: aDepartment of Medicine, VA Eastern Colorado Health Care System, Denver, Colorado bDepartment of Medicine, Rochester General Hospital, Rochester, New York cSaint Luke's Mid-America Heart Institute, Kansas City, Missouri dDepartment of Medicine, Cardiovascular Division, Brigham and Women's Hospital eDepartment of Quality, Safety, and Value, Partners Healthcare fDepartment of Medicine, Division of Cardiology, Beth Israel Deaconess, Boston, Massachusetts, USA.
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Waldo
authors.forename: Farhad
authors.initials: F
authors.lastname: Abtahian
authors.forename: Kevin F
authors.initials: KF
authors.lastname: Kennedy
authors.forename: Benjamin M
authors.initials: BM
authors.lastname: Scirica
authors.forename: Sadiqa
authors.initials: S
authors.lastname: Mahmood
authors.forename: Robert W
authors.initials: RW
authors.lastname: Yeh
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D000369:Aged, 80 and over; D001900:Boston; D016009:Chi-Square Distribution; D002908:Chronic Disease; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D054059:Coronary Occlusion / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000401:mortality; D012042:Registries; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome