Complete vs Incomplete Revascularization in Multivessel Coronary Artery Disease
The goal of coronary artery disease (CAD) treatment is coronary revascularization and repair of cardiac perfusion. Subsequently, revascularization tends to reduce long-term mortality, yet very few data exist to show a definite benefit of complete revascularization (CR) vs incomplete revascularization (IR) in clinical practice.
A study from the Journal of the American College of Cardiology has found that CR may be the most suitable revascularization method for patients with multivessel CAD. The study was a systematic review and meta-analysis of published studies (observational and randomized clinical trials) that compared CR vs IR in multivessel CAD. All-cause mortality was used as the primary outcome. Approximately 35 studies were identified, which included nearly 90,000 patients.
Roughly half of these patients received CR (50.5%) and the other half received IR (49.5%). Following analysis, authors found that IR was more common following a percutaneous coronary intervention (PCI) than coronary artery bypass graft (CABG) surgery. Also, CR was associated with low long-term mortality (relative to IR) as well as reduced myocardial infarction and repeat coronary revascularization (Figure 1). Irrespective of revascularization modality, mortality benefit in regards to CR was consistent across all studies.
Figure 1 - Total Mortality in PCI Studies - Pooled Analysisa
- Garcia S, Sandoval Y, et al. Outcomes After Complete Versus Incomplete Revascularization of Patients With Multivessel Coronary Artery Disease. J Am Coll Cardiol. 2013;62(16):1421-1431. doi:10.1016/j.jacc.2013.05.033