Influence of Pre-PTCA Strategy and Initial PTCA Result in Patients With Multivessel Disease

Abstract

Background-In PTCA patients with multivessel coronary artery disease, incomplete revascularization (IR) is the result of both pre-PTCA strategy and initial lesion outcome. The unique contribution of these components on long-term patient outcome is uncertain. Methods and Results-From the Bypass Angioplasty Revascularization Investigation (BARI), 2047 patients who underwent first-time PTCA were evaluated. Before enrollment, all significant lesions were assessed by the PTCA operator for clinical importance and intention to dilate. Complete revascularization (CR) was defined as successful dilatation of all clinically relevant lesions. Planned CR was indicated in 65% of all patients. More lesions were intended for PTCA in these patients compared with those with planned IR (2.8 versus 2.1). Successful dilatation of all intended lesions occurred in 45% of patients with planned CR versus 56% with planned IR (PϽ0.001). In multivariable analysis, planned IR (versus planned CR), initial lesions attempted (not all versus all intended lesions attempted), and initial lesion outcome (not all versus all attempted lesions successful) were unrelated to 5-year risk of cardiac death or death/myocardial infarction but were all independently related to risk of CABG. Conclusions-Overall, a pre-PTCA strategy of IR in BARI-like patients appears comparable to a strategy of CR except for a higher need for CABG. Whether the use of new devices may attenuate the elevated risk of CABG in patients with multivessel disease and planned IR remains to be determined. (Circulation. 1999;100:910-917.)

Benefit of Complete Revascularization in Patients With Multivessel Coronary Disease in the Drug-Eluting Stent Era

“…Five hundred and fifty propensity score-matched patients were followed for a median of 3.9 years (inter-quartile range: 3.1-4.8 years). The cumulative rate of death was 7.2% in the CR group vs. 16 Table 3).…”

Complete Versus Incomplete Revascularization With Coronary Artery Bypass Graft or Percutaneous Intervention in Stable Coronary Artery Disease

“…Despite unfavorable baseline characteristics of the IR group, a pre-PTCA strategy of IR or IR because of unsuccessful but intended CR was unrelated to 5-year risk of cardiac death or death/myocardial infarction compared with CR, but were all independently related to the need for CABG. 33 In contrast, more recent data in the later BMS and DES era, especially in patients with CTO, suggest that CR has a small but statistically significant survival benefit over IR.…”

“…10 CABG, coronary artery bypass graft; CVA, cerebrovascular accident; MI, myocardial infarction; PTCA, percutaneous transluminal coronary angioplasty. 33 investigated the differential impact of a pre-PTCA strategy of IR versus IR because of initial lesion outcome. Despite unfavorable baseline characteristics of the IR group, a pre-PTCA strategy of IR or IR because of unsuccessful but intended CR was unrelated to 5-year risk of cardiac death or death/myocardial infarction compared with CR, but were all independently related to the need for CABG.…”

Incomplete Revascularization in the Era of Drug-Eluting Stents

“…Although multiple studies (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17) have compared outcomes of patients who have been completely and incompletely revascularized with PCI, few of these are recent.…”