Abstract 13466: Adjusted Risk Survival Benefit Following Angiographic Complete Percutaneous Revascularization in the Era of Drug-Eluting Stents
Background: A conservative approach consisting of percutaneous intervention (PCI) of ischemic lesions has been associated with better outcomes; however, these findings are based on studies that predate the DES era. Additional studies are necessary to test the hypothesis of whether the CR in the DES era is associated with survival improvement.
Objectives: To investigate the outcome of patients undergoing complete (CR) vs. incomplete (IR) angiographic revascularization by means of PCI in the drug-eluting stent era.
Methods: Multivessel patients (≥2 major epicardial vessels with >70% stenosis) who underwent PCI with at least 1 DES implantation were classified as CR if all epicardials and significant branches (≥2.5 mm) were treated or IR otherwise. The primary end point was the adjusted risk for mortality and Q-wave MI for CR and IR at 1 year. Secondary end points were the adjusted risk mortality according to the diseased territory (proximal/middle vs. distal) and the incidence of stent thrombosis (ST).
Results: The population comprises 2132 consecutive patients with 4299 lesions.Overall, the mean age was 66 ± 12 years, 36% of diabetics, 75% of the entire population received at least 1 DES and 41% had CR. The CR group had more lesions dilated (2.5 ± 1.1 vs. 1.6 ± 1.0; p <.01) and greater total stent length (43 mm ± 23 vs. 31 ± 19; p <.01). The IR group had a higher prevalence of peripheral vascular disease (14 vs. 19%; p <.01) and chronic renal failure (13 vs. 18%; p <.01). The IR group was associated a higher adjusted risk (HR:1.6 CI 95%:1.01-2.6) for death/QMI at 1 year. (Figure) A trend towards a higher adjusted risk in patients with proximal/middle vessels segments (HR: 3.3 CI 95%:0.4-27) and ST (1.0 vs. 0.3%; p=.07) was noted in the IR group.
Conclusions: In the DES era, angiographic CR was independently associated with lower risk of death/QMI at 1 year. A trend towards less stent thrombosis was noted in the CR group despite more lesions treated and stents implanted.
- © 2013 by American Heart Association, Inc.