title: Impact of Incomplete Percutaneous Revascularization in Patients With Multivessel Coronary Artery Disease: A Systematic Review and Meta-Analysis.
abstract: Up to half of patients undergoing percutaneous coronary intervention have multivessel coronary artery disease (MVD) with conflicting data regarding optimal revascularization strategy in such patients. This paper assesses the evidence for complete revascularization (CR) versus incomplete revascularization in patients undergoing percutaneous coronary intervention, and its prognostic impact using meta-analysis.
  
  
  
  A search of PubMed, EMBASE, MEDLINE, Current Contents Connect, Google Scholar, Cochrane library, Science Direct, and Web of Science was conducted to identify the association of CR in patients with multivessel coronary artery disease undergoing percutaneous coronary intervention with major adverse cardiac events and mortality. Random-effects meta-analysis was used to estimate the odds of adverse outcomes. Meta-regression analysis was conducted to assess the relationship with continuous variables and outcomes. Thirty-eight publications that included 156 240 patients were identified. Odds of death (OR 0.69, 95% CI 0.61-0.78), repeat revascularization (OR 0.60, 95% CI 0.45-0.80), myocardial infarction (OR 0.64, 95% CI 0.50-0.81), and major adverse cardiac events (OR 0.63, 95% CI 0.50-0.79) were significantly lower in the patients who underwent CR. These outcomes were unchanged on subgroup analysis regardless of the definition of CR. Similar findings were recorded when CR was studied in the chronic total occlusion (CTO) subgroup (OR 0.65, 95% CI 0.53-0.80). A meta-regression analysis revealed a negative relationship between the OR for mortality and the percentage of CR.
  
  
  
  CR is associated with reduced risk of mortality and major adverse cardiac events, irrespective of whether an anatomical or a score-based definition of incomplete revascularization is used, and this magnitude of risk relates to degree of CR. These results have important implications for the interventional management of patients with multivessel coronary artery disease.
authors.affiliation: Department of Cardiology, Prince of Wales Hospital, Sydney, New South Wales, Australia.
authors.forename: Vinayak
authors.initials: V
authors.lastname: Nagaraja
authors.affiliation: Department of Cardiology, Prince of Wales Hospital, Sydney, New South Wales, Australia.
authors.forename: Sze-Yuan
authors.initials: SY
authors.lastname: Ooi
authors.affiliation: Royal Stoke University Hospital, University Hospitals of North Midlands, Stoke-on-Trent, United Kingdom.|Keele Cardiovascular Research Group, Institute of Science and Technology in Medicine, University of Keele, Stoke-on-Trent, United Kingdom.
authors.forename: James
authors.initials: J
authors.lastname: Nolan
authors.affiliation: Royal Stoke University Hospital, University Hospitals of North Midlands, Stoke-on-Trent, United Kingdom.
authors.forename: Adrian
authors.initials: A
authors.lastname: Large
authors.affiliation: The James Cook University Hospital, Middlesbrough, United Kingdom.
authors.forename: Mark
authors.initials: M
authors.lastname: De Belder
authors.affiliation: Queen Elizabeth Hospital, Birmingham, United Kingdom.
authors.forename: Peter
authors.initials: P
authors.lastname: Ludman
authors.affiliation: Division of Cardiology, Department of Medicine and Department of Epidemiology & Biostatistics, London Health Sciences Centre, Western University, London, Ontario, Canada.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Bagur
authors.affiliation: University Hospital Southampton & Faculty of Medicine University of Southampton, United Kingdom.
authors.forename: Nick
authors.initials: N
authors.lastname: Curzen
authors.affiliation: Division of Cardiology, Tokai University School of Medicine, Isehara, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Matsukage
authors.affiliation: Division of Cardiology, Tokai University School of Medicine, Isehara, Japan.
authors.forename: Fuminobu
authors.initials: F
authors.lastname: Yoshimachi
authors.affiliation: Royal Stoke University Hospital, University Hospitals of North Midlands, Stoke-on-Trent, United Kingdom.|Keele Cardiovascular Research Group, Institute of Science and Technology in Medicine, University of Keele, Stoke-on-Trent, United Kingdom.
authors.forename: Chun Shing
authors.initials: CS
authors.lastname: Kwok
authors.affiliation: Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom.
authors.forename: Colin
authors.initials: C
authors.lastname: Berry
authors.affiliation: Royal Stoke University Hospital, University Hospitals of North Midlands, Stoke-on-Trent, United Kingdom mamasmamas1@yahoo.co.uk.|Keele Cardiovascular Research Group, Institute of Science and Technology in Medicine, University of Keele, Stoke-on-Trent, United Kingdom.
authors.forename: Mamas A
authors.initials: MA
authors.lastname: Mamas
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery*; D054059:Coronary Occlusion / Q000601:surgery; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods* / Q000401:mortality; D062645:Percutaneous Coronary Intervention / Q000379:methods* / Q000401:mortality; D017594:Publication Bias; D016032:Randomized Controlled Trials as Topic; D012044:Regression Analysis; D012086:Reoperation; D012307:Risk Factors; D015607:Stents
keywords: complete revascularization; incomplete revascularization; major adverse cardiovascular events; mortality; percutaneous coronary intervention