Benefit of complete revascularization in patients with multivessel coronary disease in the drug-eluting stent era.

BACKGROUND

The benefit of complete (CR) vs. incomplete revascularization (IR) with drug-eluting stent (DES), unlike with bypass grafting, is not well established in patients with multivessel coronary artery disease (MVD).

METHODS AND RESULTS

Consecutive patients from a single center DES registry who were newly diagnosed as having MVD and who underwent successful percutaneous coronary intervention between March 2003 and December 2009 were traced for the occurrence of death, myocardial infarction (MI), and repeat revascularization. Among 845 patients (337 with CR and 508 with IR), propensity score-matched 275 pairs were followed for a median of 3.9 years. The adjusted hazard ratio (HR) of CR [95% confidence interval] was 0.66 [0.34-1.28] for death; 0.51 [0.28-0.95] for death and MI; 0.84 [0.60-1.19] for death, MI, and repeat revascularization. The observed benefit of CR was also cardiac-specific. The adjusted HR of CR for cardiac death and MI was 0.39 [0.16-0.96]. In 3 subgroups of patients with diabetes (n=191), ejection fraction <55% (n=153) and estimated glomerular filtration rate (eGFR) <60 ml/min (n=170), the benefit of CR was pronounced with the adjusted HR for cardiac death and MI of 0.27 [0.08-0.93], 0.18 [0.05-0.68] and 0.27 [0.07-0.99], respectively.

CONCLUSIONS

In MVD patients treated with DES, CR was associated with the long-term benefit in reducing any or cardiac death and MI. The main beneficiaries of CR were those with diabetes, low ejection fraction and low eGFR.