Complete Revascularization Found to Improve Outcomes After CABG or PCI
Complete revascularization (CR) was associated with significantly lower morbidity and mortality compared with incomplete revascularization, according to a meta-analysis published June 4 in the Journal of the American College of Cardiology.
The study also found that complete revascularization was achieved most often with CABG than with PCI and that complete revascularization provided clinical outcome benefits versus incomplete revascularization regardless of how it was defined, whether anatomically or physiologically.
"The findings of this study have several practical implications for cardiologists and surgeons alike," wrote the authors. "First, given the strong clinical benefit in patients with multivessel disease, [complete revascularization] may be the optimal revascularization strategy. The likelihood of achieving CR with either revascularization modality, ideally estimated by a heart-team approach, should influence the decision to proceed with CABG or PCI."
The authors suggested that complete revascularization may improve clinical outcomes by reducing myocardial ischemia, improving exercise capacity, reducing the risk of arrhythmic events and improving the patient's tolerance to future acute coronary ischemic events.
In an accompanying editorial, Dean J. Kereiakes, MD, FACC, wrote, "… as CR appears to confer a survival advantage, objective assessment(s) of the completeness of revascularization should be incorporated into procedural quality/performance metrics as well as criteria for appropriate utilization."
He further suggests that a standardized consensus definition of complete revascularization that incorporates both anatomic and physiologic data should be developed to enhance clinical trial analyses in the future.
Keywords: Coronary Artery Disease, Myocardial Infarction, Coronary Artery Bypass, United States, Percutaneous Coronary Intervention
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