Abstract 1144: Complete Revascularization of Patients Undergoing Multivessel PCI is an Independent Predictor of Improved Long-Term Survival
The prognostic relevance of completeness of revascularization (CR) in patients with coronary multivessel disease (MV-CAD) has so far only been established for surgical treatment strategies. Therefore we investigated the prognostic impact of CR in patients with CAD undergoing multivessel PCI (MV-PCI). Long-term survival was assesed in 679 consecutive patients (pts), who underwent MV-PCI. 47% were treated for acute myocardial infarction. We adapted two common definitions of CR from the CABG trials for our study population: ARTS -successful treatment of all relevant lesions; BARI - no residual stenosis in the LAD. CR according to the ARTS definition was achieved in 73% of the stable patients as compared to only 61% in acute pts. CR (BARI) was achieved in 95% of all pts. Patients with CR demonstrated a better long-term survival (see figure⇓). Using a multivariable cox regression analysis, procedural factors such as left main PCI, number of diseased vessels, number of treated lesions, number of stents, total stent length, and acuity of underlying CAD did not predict survival. Independent predictors (p<0.05) of long-term mortality were age (> 60y HR 2.36), reduced LVEF (LVEF<40% HR 3.44), female gender (HR 1.67), chronic renal failure (creatinine > 200 mmol/l HR 2.68), elevated CRP (HR 2.09) as well as CR (ARTS; HR 0.46). An open LAD after procedure and PCI on at least one additional vessel (BARI) did not independently predict improved survival. Achievement of CR of all segments is associated with improved survival after PCI in pts with multivessel disease, regardless of the indication for PCI (acute MI or stable CAD).