BACKGROUND: The purpose of this study was to compare the safety, efficacy, and costs of complete versus "culprit" vessel revascularization in multivessel coronary artery disease treated with percutaneous coronary interventions (PCI). METHODS:Patients with multivessel disease and an identified culprit vessel were randomly assigned to complete revascularization of vessels > or =50% stenoses (n = 108) versus revascularization limited to the culprit vessel (n = 111). The primary end point, major adverse cardiac events (MACE), were defined as cardiac or noncardiac death, myocardial infarction, need for coronary artery bypass graft surgery, and repeat PCI up to 1 year. RESULTS: Despite equal MACE at 24 hours (6.3% vs 7.4%), strategy success was higher in the culprit vessel than in the complete revascularization group (93.7% vs 81.5%, P =.007). MACE rates at 1 month (14.4% vs 9.3%), 1 year (32.4% vs 26.9%), and 4.6 +/- 1.2 years (40.4% vs 34.6%) were similar in both groups. Repeat PCI was performed more often in the culprit vessel group (31.2% vs 21.2%, P =.06). A lower consumption of medical material was associated with lower procedural costs in the culprit vessel group (5784 vs 7315 Euros; P <.001). However, between 1 year and the end of follow-up, costs had equalized in both groups. CONCLUSIONS: Complete versus culprit vessel revascularization in multivessel coronary disease treated with PCI was associated with a lower strategy success rate, similar MACE rates, and initially higher costs. However, over the long term, more repeat PCIs were conducted in patients treated by culprit revascularization only, mostly because of the need to treat lesions initially left untreated. As a consequence, incremental costs had equalized within 1 year. The decision of whether to perform culprit vessel or complete revascularization can be made on an individual basis.
RCT Entities:
BACKGROUND: The purpose of this study was to compare the safety, efficacy, and costs of complete versus "culprit" vessel revascularization in multivessel coronary artery disease treated with percutaneous coronary interventions (PCI). METHODS:Patients with multivessel disease and an identified culprit vessel were randomly assigned to complete revascularization of vessels > or =50% stenoses (n = 108) versus revascularization limited to the culprit vessel (n = 111). The primary end point, major adverse cardiac events (MACE), were defined as cardiac or noncardiac death, myocardial infarction, need for coronary artery bypass graft surgery, and repeat PCI up to 1 year. RESULTS: Despite equal MACE at 24 hours (6.3% vs 7.4%), strategy success was higher in the culprit vessel than in the complete revascularization group (93.7% vs 81.5%, P =.007). MACE rates at 1 month (14.4% vs 9.3%), 1 year (32.4% vs 26.9%), and 4.6 +/- 1.2 years (40.4% vs 34.6%) were similar in both groups. Repeat PCI was performed more often in the culprit vessel group (31.2% vs 21.2%, P =.06). A lower consumption of medical material was associated with lower procedural costs in the culprit vessel group (5784 vs 7315 Euros; P <.001). However, between 1 year and the end of follow-up, costs had equalized in both groups. CONCLUSIONS: Complete versus culprit vessel revascularization in multivessel coronary disease treated with PCI was associated with a lower strategy success rate, similar MACE rates, and initially higher costs. However, over the long term, more repeat PCIs were conducted in patients treated by culprit revascularization only, mostly because of the need to treat lesions initially left untreated. As a consequence, incremental costs had equalized within 1 year. The decision of whether to perform culprit vessel or complete revascularization can be made on an individual basis.
Authors: Claudio A Bravo; Sameer A Hirji; Deepak L Bhatt; Rachna Kataria; David P Faxon; E Magnus Ohman; Kevin L Anderson; Akil I Sidi; Michael H Sketch; Stuart W Zarich; Asishana A Osho; Christian Gluud; Henning Kelbæk; Thomas Engstrøm; Dan Eik Høfsten; James M Brennan Journal: Cochrane Database Syst Rev Date: 2017-05-03
Authors: Chuntao Wu; Anne-Marie Dyer; Spencer B King; Gary Walford; David R Holmes; Nicholas J Stamato; Ferdinand J Venditti; Samin K Sharma; Icilma Fergus; Alice K Jacobs; Edward L Hannan Journal: Circ Cardiovasc Interv Date: 2011-10-04 Impact factor: 6.546
Authors: M B Nienhuis; J P Ottervanger; J-H E Dambrink; L D Dikkeschei; H Suryapranata; A W J van 't Hof; J C A Hoorntje; M J de Boer; A T M Gosselink; F Zijlstra Journal: Neth Heart J Date: 2007-05 Impact factor: 2.380
Authors: Chuntao Wu; Anne-Marie Dyer; Gary Walford; David R Holmes; Spencer B King; Nicholas J Stamato; Samin Sharma; Alice K Jacobs; Ferdinand J Venditti; Edward L Hannan Journal: Am J Cardiol Date: 2013-06-04 Impact factor: 2.778