SpringerLink
Log in

Complete versus incomplete revascularization for treatment of multivessel coronary artery disease in the drug-eluting stent era

  • Original Article
  • Published:
Heart and Vessels Aims and scope Submit manuscript

Abstract

Limited data exist regarding the impact of complete revascularization (CR) versus incomplete revascularization (IR) on the long-term outcomes of patients with multivessel coronary artery disease (MVD) who underwent percutaneous coronary intervention with drug-eluting stents. We compared major adverse cardiac events [MACE: death, myocardial infarction (MI), or any revascularization] in 873 patients and in 255 pairs generated by propensity-score matching. CR was performed in 427 patients (48.9%) and IR in 446 (51.1%). While the amount of myocardium at risk by the APPROACH score was similar between two groups (56.0 ± 14.4 vs. 56.7 ± 16.1, p = 0.49), the SYNTAX score was lower in the CR group than in the IR group (20.7 ± 9.4 vs. 23.3 ± 10.7, p < 0.01). MACE occurred in 203 patients (23.3%) during a median follow-up of 35 months. CR was associated with a lower incidence of MACE (HR 0.64; 95% CI 0.46–0.88; p < 0.01) and revascularization (HR 0.61; 95% CI 0.42–0.90; p = 0.01), but not of death (HR 0.87; 95% CI 0.48–1.57; p = 0.64) and MI (HR 0.62; 95% CI 0.23–1.67; p = 0.35). The incidence of periprocedural MI and stent thrombosis was similar in two groups (4.7% in the CR group vs. 3.6% in the IR group, p = 0.42; 1.6 vs. 1.3%, p = 0.72, respectively). After propensity-score matching, patients with CR had fewer MACE and revascularization than those with IR. In patients with MVD, CR strategy using drug-eluting stents could reduce repeat revascularization with similar death, MI, and stent thrombosis risk compared with IR strategy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Boden WE, O’Rourke RA, Teo KK, Hartigan PM, Maron DJ, Kostuk WJ, Knudtson M, Dada M, Casperson P, Harris CL, Chaitman BR, Shaw L, Gosselin G, Nawaz S, Title LM, Gau G, Blaustein AS, Booth DC, Bates ER, Spertus JA, Berman DS, Mancini GB, Weintraub WS (2007) Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med 356:1503–1516

    Article  PubMed  CAS  Google Scholar 

  2. Ndrepepa G, Mehilli J, Schulz S, Iijima R, Keta D, Byrne RA, Pache J, Seyfarth M, Schomig A, Kastrati A (2008) Prognostic significance of epicardial blood flow before and after percutaneous coronary intervention in patients with acute coronary syndromes. J Am Coll Cardiol 52:512–517

    Article  PubMed  Google Scholar 

  3. Sorajja P, Gersh BJ, Cox DA, McLaughlin MG, Zimetbaum P, Costantini C, Stuckey T, Tcheng JE, Mehran R, Lansky AJ, Grines CL, Stone GW (2007) Impact of multivessel disease on reperfusion success and clinical outcomes in patients undergoing primary percutaneous coronary intervention for acute myocardial infarction. Eur Heart J 28:1709–1716

    Article  PubMed  Google Scholar 

  4. Cosgrove DM, Loop FD, Lytle BW, Gill CC, Golding LA, Gibson C, Stewart RW, Taylor PC, Goormastic M (1985) Determinants of 10-year survival after primary myocardial revascularization. Ann Surg 202:480–490

    Article  PubMed  CAS  Google Scholar 

  5. Bell MR, Gersh BJ, Schaff HV, Holmes DR Jr, Fisher LD, Alderman EL, Myers WO, Parsons LS, Reeder GS (1992) Effect of completeness of revascularization on long-term outcome of patients with three-vessel disease undergoing coronary artery bypass surgery. A report from the Coronary Artery Surgery Study (CASS) Registry. Circulation 86:446–457

    Article  PubMed  CAS  Google Scholar 

  6. Ijsselmuiden AJ, Ezechiels J, Westendorp IC, Tijssen JG, Kiemeneij F, Slagboom T, van der Wieken R, Tangelder G, Serruys PW, Laarman G (2004) Complete versus culprit vessel percutaneous coronary intervention in multivessel disease: a randomized comparison. Am Heart J 148:467–474

    Article  PubMed  Google Scholar 

  7. Hannan EL, Racz M, Holmes DR, King SB 3rd, Walford G, Ambrose JA, Sharma S, Katz S, Clark LT, Jones RH (2006) Impact of completeness of percutaneous coronary intervention revascularization on long-term outcomes in the stent era. Circulation 113:2406–2412

    Article  PubMed  Google Scholar 

  8. Chu WW, Kuchulakanti PK, Rha SW, GebreEyesus A, Aggrey G, Torguson R, Wang B, Xue Z, Clavijo LC, Suddath WO, Pichard AD, Satler LF, Kent KM, Waksman R (2006) Impact of three or more versus a single sirolimus-eluting stent on outcomes in patients who undergo percutaneous coronary intervention. Am J Cardiol 97:606–610

    Article  PubMed  CAS  Google Scholar 

  9. Di Mario C, Mara S, Flavio A, Imad S, Antonio M, Anna P, Emanuela P, Stefano DS, Angelo R, Stefania C, Anna F, Carmelo C, Antonio C, Monzini N, Bonardi MA (2004) Single vs multivessel treatment during primary angioplasty: results of the multicentre randomised HEpacoat for cuLPrit or multivessel stenting for Acute Myocardial Infarction (HELP AMI) Study. Int J Cardiovasc Interv 6:128–133

    Google Scholar 

  10. Zahn R, Hamm CW, Schneider S, Zeymer U, Nienaber CA, Richardt G, Kelm M, Levenson B, Bonzel T, Tebbe U, Sabin G, Senges J (2005) Incidence and predictors of target vessel revascularization and clinical event rates of the sirolimus-eluting coronary stent (results from the prospective multicenter German Cypher Stent Registry). Am J Cardiol 95:1302–1308

    Article  PubMed  CAS  Google Scholar 

  11. Moreno R, Fernandez C, Hernandez R, Alfonso F, Angiolillo DJ, Sabate M, Escaned J, Banuelos C, Fernandez-Ortiz A, Macaya C (2005) Drug-eluting stent thrombosis: results from a pooled analysis including 10 randomized studies. J Am Coll Cardiol 45:954–959

    Article  PubMed  CAS  Google Scholar 

  12. Shishehbor MH, Lauer MS, Singh IM, Chew DP, Karha J, Brener SJ, Moliterno DJ, Ellis SG, Topol EJ, Bhatt DL (2007) In unstable angina or non-ST-segment acute coronary syndrome, should patients with multivessel coronary artery disease undergo multivessel or culprit-only stenting? J Am Coll Cardiol 49:849–854

    Article  PubMed  Google Scholar 

  13. Yang JH, Gwon HC, Cho SJ, Hahn JY, Choi JH, Choi SH, Lee YT, Lee SH, Hong KP, Park JE (2008) Comparison of coronary artery bypass grafting with drug-eluting stent implantation for the treatment of multivessel coronary artery disease. Ann Thorac Surg 85:65–70

    Article  PubMed  Google Scholar 

  14. Graham MM, Faris PD, Ghali WA, Galbraith PD, Norris CM, Badry JT, Mitchell LB, Curtis MJ, Knudtson ML (2001) Validation of three myocardial jeopardy scores in a population-based cardiac catheterization cohort. Am Heart J 142:254–261

    Article  PubMed  CAS  Google Scholar 

  15. Serruys PW, Morice MC, Kappetein AP, Colombo A, Holmes DR, Mack MJ, Stahle E, Feldman TE, van den Brand M, Bass EJ, Van Dyck N, Leadley K, Dawkins KD, Mohr FW (2009) Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med 360:961–972

    Article  PubMed  CAS  Google Scholar 

  16. Di Sciascio G, Patti G, Pasceri V, Gaspardone A, Colonna G, Montinaro A (2009) Efficacy of atorvastatin reload in patients on chronic statin therapy undergoing percutaneous coronary intervention: results of the ARMYDA-RECAPTURE (Atorvastatin for Reduction of Myocardial Damage During Angioplasty) Randomized Trial. J Am Coll Cardiol 54:558–565

    Article  PubMed  CAS  Google Scholar 

  17. Lee KH, Lee SR, Kang KP, Kim HJ, Lee SH, Rhee KS, Chae JK, Kim WH, Ko JK (2010) Periprocedural hemoglobin drop and contrast-induced nephropathy in percutaneous coronary intervention patients. Korean Circ J 40:68–73

    Article  PubMed  CAS  Google Scholar 

  18. Cutlip DE, Windecker S, Mehran R, Boam A, Cohen DJ, van Es GA, Steg PG, Morel MA, Mauri L, Vranckx P, McFadden E, Lansky A, Hamon M, Krucoff MW, Serruys PW (2007) Clinical end points in coronary stent trials: a case for standardized definitions. Circulation 115:2344–2351

    Article  PubMed  Google Scholar 

  19. Kip KE, Bourassa MG, Jacobs AK, Schwartz L, Feit F, Alderman EL, Weiner BH, Weiss MB, Kellett MA Jr, Sharaf BL, Dimas AP, Jones RH, Sopko G, Detre KM (1999) Influence of pre-PTCA strategy and initial PTCA result in patients with multivessel disease: the Bypass Angioplasty Revascularization Investigation (BARI). Circulation 100:910–917

    Article  PubMed  CAS  Google Scholar 

  20. van den Brand MJ, Rensing BJ, Morel MA, Foley DP, de Valk V, Breeman A, Suryapranata H, Haalebos MM, Wijns W, Wellens F, Balcon R, Magee P, Ribeiro E, Buffolo E, Unger F, Serruys PW (2002) The effect of completeness of revascularization on event-free survival at one year in the ARTS trial. J Am Coll Cardiol 39:559–564

    Article  PubMed  Google Scholar 

  21. Lagerqvist B, James SK, Stenestrand U, Lindback J, Nilsson T, Wallentin L (2007) Long-term outcomes with drug-eluting stents versus bare-metal stents in Sweden. N Engl J Med 356:1009–1019

    Article  PubMed  CAS  Google Scholar 

  22. Tamburino C, Angiolillo DJ, Capranzano P, Dimopoulos K, La Manna A, Barbagallo R, Tagliareni F, Mangiafico S, Guzman LA, Galassi AR, Bass TA (2008) Complete versus incomplete revascularization in patients with multivessel disease undergoing percutaneous coronary intervention with drug-eluting stents. Catheter Cardiovasc Interv 72:448–456

    Article  PubMed  Google Scholar 

  23. Hannan EL, Wu C, Walford G, Holmes DR, Jones RH, Sharma S, King SB 3rd (2009) Incomplete revascularization in the era of drug-eluting stents: impact on adverse outcomes. JACC Cardiovasc Interv 2:17–25

    Article  PubMed  Google Scholar 

  24. Daemen J, Wenaweser P, Tsuchida K, Abrecht L, Vaina S, Morger C, Kukreja N, Juni P, Sianos G, Hellige G, van Domburg RT, Hess OM, Boersma E, Meier B, Windecker S, Serruys PW (2007) Early and late coronary stent thrombosis of sirolimus-eluting and paclitaxel-eluting stents in routine clinical practice: data from a large two-institutional cohort study. Lancet 369:667–678

    Article  PubMed  CAS  Google Scholar 

  25. Daemen J, Kuck KH, Macaya C, LeGrand V, Vrolix M, Carrie D, Sheiban I, Suttorp MJ, Vranckx P, Rademaker T, Goedhart D, Schuijer M, Wittebols K, Macours N, Stoll HP, Serruys PW (2008) Multivessel coronary revascularization in patients with and without diabetes mellitus: 3-year follow-up of the ARTS-II (Arterial Revascularization Therapies Study-Part II) trial. J Am Coll Cardiol 52:1957–1967

    Article  PubMed  Google Scholar 

  26. Fukushima K, Kobayashi Y, Kitahara H, Iwata Y, Kuroda N, Ooyama M, Kuwabara Y, Nomura F, Komuro I (2010) Antiplatelet effect of 50-mg maintenance dose of clopidogrel compared to 200 mg ticlopidine: a preliminary study. Heart Vessels 25:41–44

    Article  PubMed  Google Scholar 

  27. Fukushima K, Kobayashi Y, Kitahara H, Iwata Y, Kuroda N, Ooyama M, Nomura F, Komuro I (2010) Effect of 450-mg loading dose of clopidogrel on platelet function in Japanese patients undergoing coronary stent placement. Heart Vessels 25:182–186

    Article  PubMed  Google Scholar 

  28. Kimura T, Morimoto T, Nakagawa Y, Tamura T, Kadota K, Yasumoto H, Nishikawa H, Hiasa Y, Muramatsu T, Meguro T, Inoue N, Honda H, Hayashi Y, Miyazaki S, Oshima S, Honda T, Shiode N, Namura M, Sone T, Nobuyoshi M, Kita T, Mitsudo K (2009) Antiplatelet therapy and stent thrombosis after sirolimus-eluting stent implantation. Circulation 119:987–995

    Article  PubMed  CAS  Google Scholar 

  29. Marzocchi A, Saia F, Piovaccari G, Manari A, Aurier E, Benassi A, Cremonesi A, Percoco G, Varani E, Magnavacchi P, Guastaroba P, Grilli R, Maresta A (2007) Long-term safety and efficacy of drug-eluting stents: two-year results of the REAL (REgistro AngiopLastiche dell’Emilia Romagna) multicenter registry. Circulation 115:3181–3188

    Article  PubMed  CAS  Google Scholar 

  30. Wallace TW, Berger JS, Wang A, Velazquez EJ, Brown DL (2009) Impact of left ventricular dysfunction on hospital mortality among patients undergoing elective percutaneous coronary intervention. Am J Cardiol 103:355–360

    Article  PubMed  Google Scholar 

  31. Tonino PA, De Bruyne B, Pijls NH, Siebert U, Ikeno F, van’ t Veer M, Klauss V, Manoharan G, Engstrom T, Oldroyd KG, Ver Lee PN, MacCarthy PA, Fearon WF (2009) Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med 360:213–224

    Article  PubMed  CAS  Google Scholar 

  32. Baptista J, Arnese M, Roelandt JR, Fioretti P, Keane D, Escaned J, Boersma E, di Mario C, Serruys PW (1994) Quantitative coronary angiography in the estimation of the functional significance of coronary stenosis: correlations with dobutamine-atropine stress test. J Am Coll Cardiol 23:1434–1439

    Article  PubMed  CAS  Google Scholar 

  33. Bartunek J, Sys SU, Heyndrickx GR, Pijls NH, De Bruyne B (1995) Quantitative coronary angiography in predicting functional significance of stenoses in an unselected patient cohort. J Am Coll Cardiol 26:328–334

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

This work was supported by Sungkyunkwan University Foundation for Corporate Collaboration (2008-1366-000) and the IN-SUNG Foundation for Medical Research, Republic of Korea (CA88161).

Conflict of interest

There are no conflicts of interest to disclose in connection with any commercial associations for any of the authors.

Author information

Authors and Affiliations

  1. Division of Cardiology, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710, Republic of Korea

    Young Bin Song, Sang-Yeub Lee, Joo-Yong Hahn, Seung-Hyuk Choi, **-Ho Choi, Sang Hoon Lee, Kyung Pyo Hong, Jeong Euy Park & Hyeon-Cheol Gwon

Authors
  1. Young Bin Song
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sang-Yeub Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Joo-Yong Hahn
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Seung-Hyuk Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. **-Ho Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sang Hoon Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kyung Pyo Hong
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jeong Euy Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Hyeon-Cheol Gwon
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Joo-Yong Hahn or Hyeon-Cheol Gwon.

Additional information

Y.B. Song and S.-Y. Lee contributed equally to this work.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Song, Y.B., Lee, SY., Hahn, JY. et al. Complete versus incomplete revascularization for treatment of multivessel coronary artery disease in the drug-eluting stent era. Heart Vessels 27, 433–442 (2012). https://doi.org/10.1007/s00380-011-0173-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00380-011-0173-x

Keywords

Search

Navigation