Reference: Wu C, Dyer AM, Kinas SB, et al. Impact of incomplete revascularization on long-term mortality after coronary stenting. Circ Cardiovasc Interv 2011; 4: 413-21.
Complete revascularization was defined as a reduction of stenosis to less than 50% in all diseased (≥ 70% stenosis) lesions in major epicardial coronary vessels at the initial hospitalization or within 30 days after discharge before having a new MI.
Complete and incomplete revascularization were obtained in 29.2% (n = 3,803) and 70.8% (n = 9,213) of patients, respectively. Those with incomplete revascularization were older and more likely to be Hispanic or black, have lower ejection fraction values, and have 3-vessel disease total occlusion. They also showed higher rates of comorbidities such as MI, cerebrovascular disease, PAD, and CHF.
To compensate for these differences, the researchers performed a propensity analysis that matched the complete revascularization cohort to an equal number of patients with incomplete revascularization who had similar baseline risk. Among the 3,803 pair-matched subjects, 8-year survival rates were higher among those with complete vs. incomplete revascularization (80.8% vs. 78.5%; P = 0.04). The likelihood of mortality grew higher when more than one vessel was incompletely treated, although the difference did not reach statistical significance Despite the ongoing debate for or against complete revascularization, Dr. Hannan noted that this “study continues to show that there is a danger of incomplete revascularization and so certainly that is something that needs to be considered when doing this procedure.” Future research should include stress tests and fractional flow reserve, he said, but acknowledged that this can be difficult to do since these tests are not performed on all patients.
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