Kristina Hambraeus1, Karin Jensevik2, Bo Lagerqvist3, Bertil Lindahl3, Roland Carlsson4, Ramin Farzaneh-Far5, Thomas Kellerth6, Elmir Omerovic7, Gregg Stone8, Christoph Varenhorst3, Stefan James3. 1. Department of Cardiology, Falun Hospital, Falun, Sweden; Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden. Electronic address: Kristina.hambraeus@ltdalarna.se. 2. Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden. 3. Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden; Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden. 4. PCI Unit, Department of Cardiology, Central Hospital, Karlstad, Sweden. 5. Gilead Sciences, Inc., Foster City, California. 6. Department of Cardiology, University Hospital, Örebro, Sweden. 7. Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden. 8. New York Presbyterian Hospital, Columbia University Medical Center, and the Cardiovascular Research Foundation, New York, New York.
Abstract
OBJECTIVES: The aim of this study was to describe current practice regarding completeness of revascularization in patients with multivessel disease undergoing percutaneous coronary intervention (PCI) and to investigate the association of incomplete revascularization (IR) with death, repeat revascularization, and myocardial infarction (MI) in a large nationwide registry. BACKGROUND: The benefits of multivessel PCI are controversial. METHODS: Between 2006 and 2010 we identified 23,342 patients with multivessel disease in the SCAAR (Swedish Coronary Angiography and Angioplasty Registry) and merged data with official Swedish health data registries. IR was defined as any nontreated significant (60%) stenosis in a coronary artery supplying >10% of the myocardium. RESULTS: Patients with IR (n = 15,165) were older, had more extensive coronary disease, and more often had ST-segment elevation MI at presentation than those with complete revascularization (CR) (n = 8,177). All-cause 1-year mortality, MI, and repeat revascularization were higher in IR than CR: 7.1% versus 3.8%, 10.4% versus 6.0%, and 20.5% versus 8.5%, respectively. Propensity score methodology was used in the adjusted analyses. Adjusted hazard ratio (HR) for the composite of death, MI, or repeat revascularization at 1 year was higher in IR than CR: 2.12 (95% confidence interval [CI]: 1.98 to 2.28; p < 0.0001). Adjusted HR for death and the combination of death/MI were 1.29 (95% CI: 1.12 to 1.49; p = 0.0005) and 1.42 (95% CI: 1.30 to 1.56; p < 0.0001), respectively. CONCLUSIONS: Incomplete revascularization at the time of hospital discharge in patients with multivessel disease undergoing PCI is associated with a high risk of recurrent 1-year adverse cardiac events.
OBJECTIVES: The aim of this study was to describe current practice regarding completeness of revascularization in patients with multivessel disease undergoing percutaneous coronary intervention (PCI) and to investigate the association of incomplete revascularization (IR) with death, repeat revascularization, and myocardial infarction (MI) in a large nationwide registry. BACKGROUND: The benefits of multivessel PCI are controversial. METHODS: Between 2006 and 2010 we identified 23,342 patients with multivessel disease in the SCAAR (Swedish Coronary Angiography and Angioplasty Registry) and merged data with official Swedish health data registries. IR was defined as any nontreated significant (60%) stenosis in a coronary artery supplying >10% of the myocardium. RESULTS:Patients with IR (n = 15,165) were older, had more extensive coronary disease, and more often had ST-segment elevation MI at presentation than those with complete revascularization (CR) (n = 8,177). All-cause 1-year mortality, MI, and repeat revascularization were higher in IR than CR: 7.1% versus 3.8%, 10.4% versus 6.0%, and 20.5% versus 8.5%, respectively. Propensity score methodology was used in the adjusted analyses. Adjusted hazard ratio (HR) for the composite of death, MI, or repeat revascularization at 1 year was higher in IR than CR: 2.12 (95% confidence interval [CI]: 1.98 to 2.28; p < 0.0001). Adjusted HR for death and the combination of death/MI were 1.29 (95% CI: 1.12 to 1.49; p = 0.0005) and 1.42 (95% CI: 1.30 to 1.56; p < 0.0001), respectively. CONCLUSIONS: Incomplete revascularization at the time of hospital discharge in patients with multivessel disease undergoing PCI is associated with a high risk of recurrent 1-year adverse cardiac events.
Authors: Edward L Hannan; Ye Zhong; Peter B Berger; Alice K Jacobs; Gary Walford; Frederick S K Ling; Ferdinand J Venditti; Spencer B King Journal: JAMA Cardiol Date: 2018-02-01 Impact factor: 14.676
Authors: Nuccia Morici; Gianfranco Alicandro; Luca A Ferri; Luigi Piatti; Daniele Grosseto; Paolo Sganzerla; Giovanni Tortorella; Maurizio Ferrario; Gabriele Crimi; Irene Bossi; Stefano Tondi; Anna Sonia Petronio; Matteo Mariani; Anna Toso; Amelia Ravera; Elena Corrada; Davide Cao; Leonardo Di Ascenzo; Carlo La Vecchia; Stefano De Servi; Stefano Savonitto Journal: CJC Open Date: 2020-03-20
Authors: Vinayak Nagaraja; Sze-Yuan Ooi; James Nolan; Adrian Large; Mark De Belder; Peter Ludman; Rodrigo Bagur; Nick Curzen; Takashi Matsukage; Fuminobu Yoshimachi; Chun Shing Kwok; Colin Berry; Mamas A Mamas Journal: J Am Heart Assoc Date: 2016-12-16 Impact factor: 5.501