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The Negative Impact of Incomplete Angiographic Revascularization on Clinical Outcomes and Its Association With Total Occlusions in the SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) Trial
Study Questions:
What is the impact of incomplete revascularization on the outcome of patients undergoing percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) for complex coronary artery disease?
Methods:
The authors assessed the impact of complete versus incomplete revascularization in patients undergoing PCI or CABG in the SYNTAX trial and registry. Complete revascularization was defined as the successful treatment of any lesion with >50% diameter stenosis in vessels ≥1.5 mm.
Results:
Angiographic complete revascularization was achieved in 52.8% of the PCI arm and 66.9% of the CABG arm. Within the PCI and CABG arms, incomplete revascularization was associated with a greater burden of coronary artery disease and greater anatomical complexity. Incomplete revascularization was associated with significantly higher 4-year mortality, revascularization, stent thrombosis (PCI arm), and major adverse cardiac and cerebrovascular events. The strongest predictor of incomplete revascularization in patients undergoing PCI was the presence of total occlusions (hazard ratio, 2.70; 95% confidence interval, 1.98-3.67; p < 0.001).
Conclusions:
The authors concluded that in patients treated with either PCI or CABG, incomplete revascularization is associated with an adverse long-term outcome.
Perspective:
This study suggests that among patients with advanced coronary disease, incomplete revascularization is associated with an adverse long-term outcome. This essentially reflects the fact that patients who cannot be completely revascularized have more complex disease. While in general CABG is more successful at ensuring complete revascularization, it is noteworthy that one third of patients undergoing CABG did not get completely revascularized in this study. The choice of revascularization strategy in patients with coronary artery disease should be based on, among other factors, the completeness of intended revascularization.
Keywords: Coronary Artery Disease, Thrombosis, Coronary Disease, Coronary Artery Bypass, Cardiac Surgical Procedures, Angioplasty, Balloon, Coronary, Stents, Percutaneous Coronary Intervention
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