BackgroundUp 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.Methods and ResultsA 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.Conclusion
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.
In this large multicentre randomised trial, the GSS6Fr was associated with a low event rate for the primary endpoint (RAO), although non-inferiority to the GS5Fr was not met, due to a lower than expected rate of RAO in the GS5Fr group. As compared to institutional haemostasis, the use of patent haemostasis was not associated with a reduced rate of RAO.
Slender TRI is a new challenge to maximise patient value by improving outcome and reducing costs during TRI. Materials and techniques are continuously being refined and miniaturised to the highest standards. Whether outcome improves while reducing costs remains to be validated.
Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp dge re-stenosis is a major problem following sirolimus-eluting stent (SES) implantation for the treatment of native coronary artery lesions. 1 To minimize the incidence of these events, longitudinal positioning of SES is considered to be critically important. Due to the current lack of a standard guideline, however, practitioners must decide the landing position by a somewhat arbitrary assessment in the actual clinical setting. The SIRIUS trial that used intravascular ultrasound (IVUS) to investigate lesions reported that the residual plaque burden is associated with edge re-stenosis. 2 Of particular interest, edge re-stenosis was mostly observed in cases of residual plaque area (PA)/volume >50% at the stent margins. According to these observations, we (1) determined unique stepwise IVUS criteria to achieve optimal longitudinal positioning of SES using plaque burden at the peri-stent margins, which might fit a variety of actual lesion subsets (Figure 1), and (2) have put them to practical use continuously. Because long-term clinical and angiographic outcomes are currently available, we verified these new criteria in terms of achievability and their actual impact on margin re-stenosis rates and long-term clinical outcomes.
Methods
Study PopulationFrom January 2005 to April 2006, 162 consecutive stable angina patients whose native coronary lesions were electively treated with SES were studied at Tokai University School of Medicine. SES were implanted according to the IVUS criteria (Figure 1) of longitudinal stent positioning, which were determined with reference to the previous investigation. 2 A cut-off for plaque burden of <50% in the criteria was determined by either (1) visual assessment with reference to Figure 1 or (2) measurement by manual tracing using a software package installed in the IVUS console during the procedure. The consecutive patients who had completion of poststenting (after final balloon dilation) IVUS pullback were the subjects of the present study. Patients with native coronary
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