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Incomplete revascularization linked to high event rate at 1 year in PCI for multivessel disease
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In patients with multivessel disease treated with PCI, incomplete revascularization at hospital discharge was linked to a high risk for recurrent 1-year adverse CV events, according to new data.
Researchers analyzed data from the SWEDEHEART, SCAAR and national health care registries of Sweden. They identified 23,342 consecutive patients (median age, 68 years; 27% women) underwent PCI multivessel disease between 2006 and July 2010. Follow-up occurred after the last PCI performed during index hospitalization. Revascularization status was determined after the last procedure performed after hospital discharge.
The primary objective of the study was to determine correlations between incomplete revascularization (60% stenosis in coronary artery supplying more than 10% of myocardium) compared with complete revascularization using the prespecified composite endpoint of all-cause mortality, MI and repeat revascularization at 12 months.
Overall, 15,165 patients were determined to have had incomplete revascularization. Compared with complete revascularization, those with incomplete revascularization were older, had more extensive coronary disease and were more likely to have presented with STEMI.
Overall, 5,071 events of the primary composite endpoint occurred in patients with incomplete revascularization compared with 1,254 events in patients with complete revascularization (unadjusted HR = 2.48; 95% CI, 2.33-2.64). Multivariable adjustment that included the propensity score found a persistent difference between the incomplete revascularization and complete revascularization groups in the risk for death, MI or repeat revascularization (adjusted HR = 2.12; 95% CI, 1.98-2.28). At 30 days post-PCI, the event rate was 1,702 in the incomplete revascularization group vs. 347 in the complete revascularization group (unadjusted HR = 2.73; 95% CI, 2.43-3.06). After 90 days, this rate was 3,351 in the incomplete revascularization group vs. 611 in the complete revascularization group (unadjusted HR = 3.19; 95% CI, 2.93-2.48). An analysis of mortality, with repeat revascularization as a time-dependent covariable, found that the unadjusted HR for incomplete revascularization vs. complete revascularization was 2.05 (95% CI, 1.8-2.32). The HR for the combined endpoint of death/MI for incomplete revascularization vs. complete revascularization was 1.92 (95% CI, 1.77-2.09).
“For patients with multivessel disease undergoing PCI, [incomplete revascularization] achieved at the time of hospital discharge was associated with a high risk of death, repeat revascularization, or MI in the first year,” the researchers wrote. “Whether this risk can be mitigated by efforts to achieve [complete revascularization], or by the use of novel adjunctive pharmacological strategies, remains to be further investigated in large randomized trials.” – by Jennifer Byrne
Disclosure: The study was supported by an unrestricted grant from Gilead Sciences, and one of the researchers is an employee of Gilead. Please see the full study for a list of all of the researchers’ relevant financial disclosures.
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