Original Title: Long-Term Outcome of Incomplete Revascularization after Percutaneous Coronary Intervention in SCAAR (Swedish Coronary Angiography and Angioplasty Registry). Reference: Kristina Hambraeus et al. J Am Coll Cardiol Intv. 2016;9(3):207-215.
The aim of this study was to describe the evolution of patients with multivessel disease undergoing PCI with incomplete revascularization, and its probable association to death, repeat revascularization and MI in the long term.
Between 2006 and 2010 23342 patients with multivessel disease were identified in the SCAAR registry (Swedish Coronary Angiography and Angioplasty Registry). Incomplete revascularization was defined as any vessel with a lesion larger than 60% irrigating at least 10% of the myocardium.
Patients with incomplete revascularization (n = 15,165) were older, with more extensive coronary disease and often had STEMI at presentation, compared to those with complete revascularization (n = 8,177).
At one year, all cause mortality, AMI and repeat revascularization rates were higher among the incomplete revascularization patients, compared to those with complete revascularization (7.1% vs 3.8%, 10.4% vs 6.0% and 20.5% vs 8.5%, respectively).
After propensity score matching, the adjusted risk at one year for the composite of death, MI or revascularization was significantly higher for the incomplete revascularization group. (HR 2.12 CI 95% 1.98 to 2.28; p < 0.0001).
The adjusted risk of death and the combination of death/MI also resulted higher for the incomplete revascularization group with 1.29 (CI 95% 1.12 to 1.49; p=0.0005) and 1.42 (CI 95% 1.30 to 1.56; p<0.0001), respectively.
Conclusion
Incomplete revascularization at discharge in patients with multivessel disease undergoing PCI is associated with a high risk of adverse cardiac events at one year.
Editorial Comment
So far, the evidence is conflictive and generally indirect. Even though this study provides important data, is limited by its retrospective character and by the fact that it was carried out in different populations, which required several adjustments for researchers to be able to compare. Clearly, in almost all studies, patients with incomplete revascularization are always at higher risk, and their treatment was determined by the impossibility to receive a complete revascularization, rather than by choice.
