The effect of completeness of revascularization on event-free survival at one year in the arts trial

Brand, Moshe; Rensing, Benno J.; Morel, Marie‐Angèle; Foley, David P.; Valk, Vincent de; Breeman, Arno; Suryapranata, Harry; Haalebos, Maximiliaan M.P; Wijns, William; Wellens, Francis; Balcon, R.; Magee, Patrick; Ribeiro, Expedito E.; Buffolo, Ênio; Unger, Felix; Serruys, Patrick W.

doi:10.1016/s0735-1097(01)01785-5

Cited by 199 publications

(117 citation statements)

References 26 publications

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“…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). CR using FFR testing to identify significant stenoses improved outcomes compared with CR based only on angiographic analysis [41].…”

Section: Strategies For Multivessel Pci Complete Versus Incomplete Rementioning

confidence: 99%

“…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.''…”

Section: Strategies For Multivessel Pci Complete Versus Incomplete Rementioning

confidence: 99%

See 1 more Smart Citation

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

Blankenship

Moussa

Chambers

et al. 2011

Cathet Cardio Intervent

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Percutaneous coronary interventions (PCIs) to treat multivessel coronary artery disease (MVCAD) may involve single-vessel or multivessel interventions, performed in one or more stages. This consensus statement reviews factors that may influence choice of strategy and includes six recommendations to guide decisions regarding staging of PCI [1]. Every patient who undergoes PCI should receive optimal therapy for coronary disease, ideally before starting the procedure [2]. Multivessel PCI at the time of diagnostic catheterization should be considered only if informed consent included the risks and benefits of multivessel PCI and the risks and benefits of alternative treatments [3]. When considering multivessel PCI, the interventionist should develop a strategy regarding which stenoses to treat or evaluate, and their order, method, and timing. This strategy should maximize patient benefits, minimize patient risk, and consider the factors described in this article [4]. For planned multivessel PCI, additional vessel(s) should be treated only if the first vessel is treated successfully and if anticipated contrast and radiation doses and patient and operator conditions are favorable [5]. After the first stage of the planned multistage PCI, the need for subsequent PCI should be reviewed before it is performed [6]. Third party payers and quality auditors should recognize that multistage PCI for MVCAD is neither an indication of poor quality nor an attempt to increase reimbursement when performed according to recommendations in this article.V C 2011 Wiley Periodicals, Inc.

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Section: Strategies For Multivessel Pci Complete Versus Incomplete Rementioning

confidence: 99%

Section: Strategies For Multivessel Pci Complete Versus Incomplete Rementioning

confidence: 99%

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

Blankenship

Moussa

Chambers

et al. 2011

Cathet Cardio Intervent

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“…[27][28][29][30] The authors performed a post-hoc analysis to determine the effect of complete revascularization on 10-year survival of patients with stable multi-vessel CAD and preserved left ventricular ejection fraction (EF) who were randomly assigned to percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) in the Second Medicine, Angioplasty, or Surgery Study (MASS II) Trial. MASS II was a randomized trial designed to compare medical treatment, angioplasty/stent treatment, and CABG in patients with multi-vessel proximal stenoses >70% with concomitant ischemia.…”

Section: Effect Of Complete Revascularization On 10-year Survival Of mentioning

confidence: 99%

Most Important Outcomes Research Papers on Treatment of Stable Coronary Artery Disease

Bikdeli¹,

Ranasinghe²,

Chen³

et al. 2013

Circ: Cardiovascular Quality and Outcomes

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The following are highlights from the new series, Circulation: Cardiovascular Quality and Outcomes Topic Review. This series will summarize the most important manuscripts, as selected by the Editor, that have been published in the Circulation portfolio. The objective of this series is to provide our readership with a timely, comprehensive selection of important papers that are relevant to the quality and outcomes, and general cardiology audience. The studies included in this article represent the most significant research related to treatment of stable coronary artery disease (CAD). (Circ Cardiovasc Quality and Outcomes. 2013; 6:e17-e25.)

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“…We could have broadened the eligibility criteria by requiring the completeness of DES revascularization to only be equal to that of CABG rather than strictly complete. Superiority of complete revascularization with PCI for multivessel disease on longterm outcomes was inconsistently demonstrated in the pre-DES era (27)(28)(29)(30)(31)(32). Another reason for this underestimation may be due to the fact that our interventional cardiologists were already managing a large number of multivessel patients with BMS in 2003, which were not included in the analyses.…”

Section: Limitationsmentioning

confidence: 99%

Potential shift from coronary bypass surgery to percutaneous coronary intervention for multivessel disease and its economic impact in the drug-eluting stent era

Poulin

Rinfret

Gobeil

2007

Canadian Journal of Cardiology

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F Poulin, S Rinfret, F Gobeil. Potential shift from coronary bypass surgery to percutaneous coronary intervention for multivessel disease and its economic impact in the drug-eluting stent era. Can J Cardiol 2007;23(14):1139-1145.BACKGROUND: Drug-eluting stents (DES) may promote percutaneous coronary intervention (PCI) procedures in patients traditionally referred for coronary artery bypass graft (CABG) surgery and may save money. OBJECTIVES: The purpose of the present study was to quantify the potential shift from CABG surgery to multivessel PCI in the DES era and to model the economic consequences. METHODS: Based on predefined criteria, the feasibility of PCI was evaluated in patients with multivessel coronary artery disease who underwent CABG surgery before the availability of DES at the Centre Hospitalier de l'Université de Montréal's Notre-Dame Hospital (Montreal, Quebec). Modelling was used to evaluate the potential cost savings using multivessel PCI instead of CABG surgery. Equal one-year outcomes in both groups were assumed, with the exception of a 10% repeat revascularization (RR) rate in the DES group and a 4% RR rate in the CABG group. The impact of those assumptions was evaluated using 1000 Monte Carlo simulations. RESULTS: The authors retrospectively evaluated that, of 289 patients who underwent CABG without concomitant valve surgery between January and December 2003, only 22 patients (8%) were good candidates for multivessel DES implantation. The procedures would have involved an average of 3.6 DES per patient. The average cost per revascularization procedure was $14,402 with surgery and $11,220 for multivessel DES implantation (using $2,200 DES), leading to a savings of $3,182 per patient. However, after including RR procedures, PCI would only have been associated with savings of $812 per surgery avoided. Monte Carlo analysis revealed that surgery may be less expensive than PCI in 36% of patients. CONCLUSIONS: Most patients who underwent CABG surgery in 2003 were retrospectively judged to be ineligible for multivessel PCI with DES. In the rare eligible patient, multivessel PCI with DES is not expected to produce savings to health care costs in Canada unless the DES purchase cost continues to decrease.

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The effect of completeness of revascularization on event-free survival at one year in the arts trial

Cited by 199 publications

References 26 publications

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

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

Most Important Outcomes Research Papers on Treatment of Stable Coronary Artery Disease

Potential shift from coronary bypass surgery to percutaneous coronary intervention for multivessel disease and its economic impact in the drug-eluting stent era

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