Incidence and predictors of incomplete revascularization in a contemporary cohort

Department

Medicine

Document Type

Article

Publication Title

Coronary Artery Disease

Abstract

OBJECTIVES: Complete coronary revascularization has been associated with improved mortality among patients undergoing surgical bypass grafting. A similar evaluation among patients undergoing percutaneous coronary intervention (PCI) for multivessel disease has produced largely concordant results, although complete percutaneous revascularization is often not achieved in this population. The present study sought to evaluate the clinical and anatomic limitations to complete revascularization among contemporary patients undergoing percutaneous revascularization for multivessel coronary artery disease. METHODS: All patients undergoing nonemergent PCI for unprotected left main or multivessel coronary artery disease were identified at two academic medical centers from 2009 to 2012. Complete revascularization was determined through a review of the electronic medical records and corresponding coronary angiograms. The underlying reasons that precluded complete revascularization were then derived from a review of the clinical and angiographic findings. RESULTS: Among 978 patients with multivessel coronary artery disease, 267 (27%) underwent complete percutaneous coronary revascularization. Factors that prevented complete revascularization included chronic total occlusions (54%), treatment limited to the culprit lesion (24%), or persistent disease in small nondominant vessels (24%). After multivariable adjustment, the presence of a chronic total occlusion was associated with significantly reduced odds of receiving complete revascularization (adjusted odds ratio: 0.18, 95% confidence interval: 0.12-0.27). CONCLUSION: Complete percutaneous revascularization is uncommon and is hindered by the presence of chronic total occlusions or isolated treatment of an angiographic culprit lesion. Evolving interventional techniques enabling treatment of chronic total occlusions may increase the prevalence of complete percutaneous revascularization in the future.

First Page

191

Last Page

8

DOI

10.1097/MCA.0000000000000353

Volume

27

Issue

3

Publication Date

5-1-2016

Medical Subject Headings

Academic Medical Centers; Aged; Aged, 80 and over; Boston; Chi-Square Distribution; Chronic Disease; Coronary Angiography; Coronary Artery Disease (diagnostic imaging, mortality, therapy); Coronary Occlusion (diagnostic imaging, mortality, therapy); Electronic Health Records; Female; Humans; Kaplan-Meier Estimate; Logistic Models; Male; Middle Aged; Multivariate Analysis; Odds Ratio; Percutaneous Coronary Intervention (adverse effects, mortality); Registries; Risk Factors; Time Factors; Treatment Outcome

PubMed ID

26882019

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