Complete versus incomplete revascularization for treatment of multivessel coronary artery disease in the drug-eluting stent era

초록

Limited data exist regarding the impact of complete revascularization (CR) versus incomplete revascularization (IR) on the long-term outcomes of patients with multivessel coronary artery disease (MVD) who underwent percutaneous coronary intervention with drug-eluting stents. We compared major adverse cardiac events [MACE: death, myocardial infarction (MI), or any revascularization] in 873 patients and in 255 pairs generated by propensity-score matching. CR was performed in 427 patients (48.9%) and IR in 446 (51.1%). While the amount of myocardium at risk by the APPROACH score was similar between two groups (56.0 +/- A 14.4 vs. 56.7 +/- A 16.1, p = 0.49), the SYNTAX score was lower in the CR group than in the IR group (20.7 +/- A 9.4 vs. 23.3 +/- A 10.7, p < 0.01). MACE occurred in 203 patients (23.3%) during a median follow-up of 35 months. CR was associated with a lower incidence of MACE (HR 0.64; 95% CI 0.46-0.88; p < 0.01) and revascularization (HR 0.61; 95% CI 0.42-0.90; p = 0.01), but not of death (HR 0.87; 95% CI 0.48-1.57; p = 0.64) and MI (HR 0.62; 95% CI 0.23-1.67; p = 0.35). The incidence of periprocedural MI and stent thrombosis was similar in two groups (4.7% in the CR group vs. 3.6% in the IR group, p = 0.42; 1.6 vs. 1.3%, p = 0.72, respectively). After propensity-score matching, patients with CR had fewer MACE and revascularization than those with IR. In patients with MVD, CR strategy using drug-eluting stents could reduce repeat revascularization with similar death, MI, and stent thrombosis risk compared with IR strategy.

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