Revascularization strategy in patients with multivessel disease and a major vessel chronically occluded; data from the CABRI trial

Abstract

In patients with multivessel coronary disease and chronic occlusion of a major epicardial vessel, achieving of a complete revascularization by reopening or bypassing the occluded vessel is associated with a significantly better long-term prognosis.

2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease

“…In general, complete revascularization leads to better outcomes than incomplete revascularization. [413][414][415][416][417][418] In patients with chronic total occlusion, CABG could be preferable to PCI, 419 but this is still controversial. Although the technology and techniques for PCI of chronic total occlusions are improving, there remains no current evidence that survival is improved after successful PCI of a chronic total occlusion.…”

Effect of Complete Revascularization on 10-Year Survival of Patients With Stable Multivessel Coronary Artery Disease

“…However, this analysis was selected in the minority of randomly assigned patients (21.2%) with a major vessel chronically occluded. 14 The potential benefit of complete revascularization on long-term mortality in patients with multivessel CAD, undergoing PCI, or CABG was demonstrated in registry studies. Recently, Hannan et al analyzed, from the New York State's Percutaneous Coronary Interventions Report System (PCIRS), the impact of complete revascularization in more than 33 000 patients who underwent PCI with BMS or drug-eluting stents (DES).…”

Clinical outcomes of multiple chronic total occlusions in coronary arteries according to three therapeutic strategies: Bypass surgery, percutaneous intervention and medication

“…Benefit was greatest among patients with more severe baseline ischemia [32,33]. Subgroup analysis of the Coronary Angioplasty versus Bypass Revascularization investigation (CABRI) trial, one of a few studies evaluating CABG and PCI in patients with CTOs, demonstrated that CABG had better outcomes in these patients with multi-vessel disease in terms of subsequent morality and risk of acute MI [34]. In post hoc study of the All-Comer SYNTAX Trial, the presence of a total occlusion was less likely to result in complete revascularization in the PCI and CABG arms, with this effect being substantially more pronounced in the PCI arm and incomplete revascularization, compared with complete revascularization, has a detrimental impact on long-term clinical outcome, including mortality [35].…”