Results of our recent poll regarding complete revascularization in chronic coronary artery disease reflect a reality: There is no standard definition of complete revascularization. Should one base the definition on revascularization of all "significant" lesions using an ischemic definition or an anatomic definition? In addition, the need for revascularization of chronic total occlusions with or without documented ischemia remains unsupported. Thus, despite a significant body of evidence demonstrating improved outcomes for complete revascularization, the actual definitions vary.

The poll results demonstrate equivalent choices of an ischemic, anatomic, or a combined definition for complete revascularization reflecting the respondent's recognition of ambiguity around an optimal definition.

In anticipation of the analysis of the impact of completeness of revascularization in ISCHEMIA (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches) based on a core laboratory, Ali and colleagues published an algorithm summarizing comparative schemes based on alleviating documented ischemic lesions or anatomically significant lesions.¹ The authors importantly point out that not every lesion may have stress nuclear or coronary flow measurements. Likewise, issues remain regarding anatomic coronary lesion assessment. Unfortunately, the algorithm is sufficiently complex that operators are unlikely to quickly incorporate it into daily decision-making.

References

1. Ali ZA, Horst J, Gaba P, et al. Standardizing the Definition and Analysis Methodology for Complete Coronary Artery Revascularization. J Am Heart Assoc 2021;10:e020110.

Clinical Topics: Atherosclerotic Disease (CAD/PAD), Invasive Cardiovascular Angiography and Intervention

Keywords: Coronary Artery Disease, Laboratories, Myocardial Ischemia, Ischemia, Vascular Diseases, Algorithms, Decision Making

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