Abstract 17887: Impact of Complete Revascularization in Acute Coronary Syndromes: Insights From the Alberta Contemporary Acute Coronary Syndrome Patients Invasive Treatment Strategies (COAPT) Registry
Introduction: Controversy exists regarding the benefits of complete revascularization (CR) compared to incomplete revascularization (IR) in acute coronary syndrome (ACS) patients with multi-vessel disease (MVD) undergoing percutaneous coronary intervention (PCI).
Hypothesis: Using a large provincial ACS registry, we examine the incidence, demographic profile and clinical outcome of ACS patients with MVD comparing IR to CR.
Methods: We evaluated 5044 ACS patients with MVD (≥70% stenosis in 2 or more vessels) hospitalized with an ACS undergoing PCI in Alberta, Canada between April 1 2010 and March 31 2013. Comparisons were made between patients who underwent CR (APPROACH jeopardy score ≤10%) within 3 months from index PCI versus patients with IR (APPROACH jeopardy score > 10%). One year outcomes in the primary composite of death or recurrent myocardial infarction (MI) and secondary composite of death, recurrent MI or repeat revascularization were explored. Logistic regression models were used to examine the multivariable-adjusted association between revascularization status and clinical outcome.
Results: Of the study cohort, 62.5% received CR. These patients were younger and less likely to have diabetes or prior cardiovascular conditions (Table). One year death occurred less frequently with CR (1.2% vs. 2.8%, p<0.0001; adjusted OR 0.60, 95%CI 0.38-0.93). One year recurrent MI was less likely with CR (1.5% vs. 3.1%, p<0.0001; adjusted OR 0.52, 95%CI 0.35-0.77). Both primary and secondary composite outcomes were reduced with CR (Table) (primary composite adjusted OR 0.55, 95%CI 0.40-0.74; secondary composite adjusted OR 0.43, 95%CI 0.36-0.53).
Conclusion: Results from this large contemporary of ACS patients with MVD undergoing PCI suggests CR occurs commonly and is associated with improved clinical outcome at one year. Given the potential for unmeasured confounders, our findings deserve confirmation in appropriately powered randomized trials.
- Acute coronary syndromes
- Interventional cardiology
- Percutaneous coronary intervention (PCI)
Author Disclosures: K. Bainey: None. P. Kaul: None. W. Alemayehu: None. P. Armstrong: None. R. Welsh: None.
- © 2016 by American Heart Association, Inc.