Effect of Complete Revascularization on 10-Year Survival of Patients With Stable Multivessel Coronary Artery Disease: MASS II Trial
What is the impact of complete revascularization on 10-year survival of patients with multivessel coronary artery disease treated with bare-metal stents (BMS) or coronary artery bypass grafting (CABG)?
This was a post-hoc analysis of the MASS II trial (Second Medicine, Angioplasty, or Surgery Study), a prospective randomized trial comparing treatments in patients with stable multivessel coronary artery disease and preserved systolic ventricular function. Overall survival time was analyzed among patients who underwent complete (CR) or incomplete revascularization (IR) in the groups receiving either percutaneous coronary intervention (PCI) or CABG.
Complete revascularization was achieved in 224 patients (57.4%), with 63.8% of these in the CABG group and 36.2% in the PCI group (p = 0.001). Although most baseline data were similar between subjects who underwent IR and CR, the IR group had more previous myocardial infarction than did the CR group (56.4% x 41.4%, respectively; p = 0.01). During 10-year follow-up, the survival free of cardiovascular mortality was significantly different among patients in the two groups (CR, 90.6% vs. IR, 84.4%; p = 0.04), an observation driven by the PCI group. That is, there was no observed difference between IR and CR in the CABG group, but a statistically significant difference was observed for the PCI group (p = 0.05).
During 10-year follow-up, CR compared with IR was associated with reduced cardiovascular mortality, an observation mainly driven by IR in those who were assigned PCI.
The present study is a post-hoc analysis of the MASS II trial that examines the impact of complete versus incomplete revascularization on 10-year survival of lower-risk patients with stable multivessel coronary artery disease and normal left ventricular ejection fraction undergoing PCI or surgical revascularization. A difference in outcome in IR versus CR was only observed in the PCI group. Although the present study adds to the literature on outcomes related to completeness of revascularization, the impact of incomplete revascularization on outcomes remains an unsettled question.
Keywords: Coronary Artery Disease, Myocardial Infarction, Follow-Up Studies, Ventricular Function, Left, Stroke Volume, Ventricular Function, Coronary Artery Bypass, Angioplasty, Angioplasty, Balloon, Coronary, Stents, Percutaneous Coronary Intervention
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