Complete versus incomplete revascularization in patients with multivessel coronary artery disease treated with drug-eluting stents.
BACKGROUND
The clinical impact of completeness of revascularization on adverse cardiovascular events remains unclear among patients with multivessel coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI).


METHODS
This analysis included consecutive patients with multivessel CAD, who underwent PCI with drug-eluting stents (DES) during the period from January 1, 2003, through to December 31, 2013. We compared the outcomes in patients, who achieved complete (CR) versus incomplete revascularization (IR) at the time of PCI. The primary outcome was death from any cause. Secondary outcomes were the rates of myocardial infarction (MI), stroke, and repeat revascularization. Propensity-score matching was used to assemble a cohort of patients with similar baseline characteristics.


RESULTS
Among 3901 patients with multivessel CAD treated with DES, 1402 pairs of similar propensity scores in each group of CR and IR were identified. At a median follow-up of 4.9 years (interquartile range, 2.4-7.5), IR was associated with a similar risk of death (hazard ratio [HR], 1.03; 95% CI, 0.80-1.32; P=.83) as compared with CR. IR was also associated with similar risks of stroke (HR, 1.26; 95% CI, 0.76-2.09; P=.37) and repeat revascularization (HR, 1.15; 95% CI, 0.93-1.41; P=.19), but associated with a higher risk of MI (HR, 1.86; 95% CI, 1.08-3.19; P=.024) compared to CR.


CONCLUSIONS
Among patients with multivessel CAD treated with DES, as compared with CR, IR was associated with similar risk of death. However, IR was associated with a higher risk of MI during follow-up.
Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Mineok
M
Chang
Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Jung-Min
JM
Ahn
Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Nayoung
N
Kim
Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Pil Hyung
PH
Lee
Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Jae-Hyung
JH
Roh
Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Sung-Han
SH
Yoon
Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Soo-Jin
SJ
Kang
Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Seung-Whan
SW
Lee
Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Young-Hak
YH
Kim
Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Cheol Whan
CW
Lee
Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Seong-Wook
SW
Park
Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. Electronic address: dwpark@amc.seoul.kr.
Duk-Woo
DW
Park
Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Seung-Jung
SJ
Park
D000368:Aged; D060050:Angina, Stable / Q000000981:diagnostic imaging / Q000601:surgery; D000789:Angina, Unstable / Q000000981:diagnostic imaging / Q000601:surgery; D015331:Cohort Studies; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000601:surgery*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009026:Mortality; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000453:epidemiology; D000072658:Non-ST Elevated Myocardial Infarction / Q000000981:diagnostic imaging / Q000601:surgery; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D057216:Propensity Score; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D016896:Treatment Outcome