Complete versus incomplete revascularization in patients with multivessel disease undergoing percutaneous coronary intervention with drug‐eluting stents

Abstract

Complete revascularization with DES of MVD patients is associated with lower rates of long-term adverse events.

Staging of multivessel percutaneous coronary interventions: An expert consensus statement from the Society for Cardiovascular Angiography and Interventions

“…PCI studies have defined CR to include arteries with diameter greater than 1.5 [63], 2.0 [64], 2.25 [65], or 2.75 mm [66] with >50 or >70% stenoses. The Writing Group suggests the following definition of CR relevant to PCI: ''revascularization of all significant arteries (as assessed by the angiographer) that threaten viable myocardium with stenoses either >70% diameter narrowing by angiography or of hemodynamic significance by stress testing or invasive assessment.''…”

“…CR is relevant to the extent that CR improves clinical outcomes. However, the clinical benefits of CR using angiographic criteria are uncertain, with some [65,[67][68][69][70] but not all [71][72][73] studies reporting superior outcomes with CR. CR does reduce the incidence of subsequent CABG [66,74] or subsequent PCI [64] (Table II).…”

To complete, or not to complete, that is the question of revascularization in percutaneous coronary intervention with drug-eluting stents for multivessel disease

“…In 3 (11,13,16) of the 5 studies, C-RV was associated with reduced R-RV. In 8 (6,9-11,13-16) of the 11 studies, C-RV was associated with reduced MAC(C)E. There were a number of important issues, however, in the aforementioned studies (1,(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17) of C-RV versus IC-RV in DES-PCI for MV-CAD (except for AMI) (Figure 1). First, "angiographic" (successful angioplasty of all diseased lesions in the major epicardial coronary vessels and their first degree side branches) and "proximal" C-RV definitions (successful angioplasty of all diseased proximal arteries) according to a study by Kim et al (18) are more accurate and clinically relevant.…”

“…Our systematic search using keywords including "complete" or "completeness"; "incomplete" or "culprit"; "revascularization"; and "drug-eluting" identified 14 studies (1,(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17) summarized in Tables 1,2. The design of all studies was a non-randomized observational study, and all but one (13) studies reported adjusted HRs for outcomes of interest in "C-RV vs. IC-RV" or "IC-RV vs. C-RV".…”

“…The design of all studies was a non-randomized observational study, and all but one (13) studies reported adjusted HRs for outcomes of interest in "C-RV vs. IC-RV" or "IC-RV vs. C-RV". Nine (1,5-7,9,11,13-15), 5 (6,8,9,16,17), 3 (1,6,11), 2 (1,6), 5 (1,6,11,13,16), and 11 studies (1,6,(8)(9)(10)(11)(12)(13)(14)(15)(16) provided HRs for all-cause death, cardiac death, MI, stroke, R-RV, and MAC(C)E, respectively. In 5 (5-7,14,15) of the 9 studies, C-RV was associated with reduced all-cause death.…”