The prognostic significance of incomplete revascularization and untreated coronary anatomy following percutaneous coronary intervention: An analysis of 6,755 patients with multivessel disease
Background More than half of the patients undergoing percutaneous coronary intervention (PCI) have multivessel disease. Whether complete revascularization impacts long‐term mortality or whether selected patients or those with specific coronary anatomy benefit from complete revascularization is uncle...
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| Veröffentlicht in: | Catheterization and cardiovascular interventions 2018-06, Vol.91 (7), p.1229-1239 |
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| creator | Iqbal, M. Bilal Smith, Robert D. Lane, Rebecca Patel, Niket Mattar, Wala Kabir, Tito Panoulas, Vasileios Mason, Mark Dalby, Miles C. Grocott‐Mason, Richard Ilsley, Charles D. |
| description | Background
More than half of the patients undergoing percutaneous coronary intervention (PCI) have multivessel disease. Whether complete revascularization impacts long‐term mortality or whether selected patients or those with specific coronary anatomy benefit from complete revascularization is unclear.
Methods
A total of 14,452 patients underwent PCI between 2004 and 2015 at Harefield Hospital, UK. Of these, 7,076 patients had multivessel disease. We excluded 321 patients with left main‐stem stenosis ≥50%, with 6,755 patients included in the analysis (936 patients had complete revascularization).
Results
The unadjusted 3‐year mortality rates were lower with complete revascularization (10.8% vs 13.1%, P = 0.047). However, multivariable‐adjusted analyses indicated that complete revascularization was not independently associated with mortality (HR = 1.01, 95% CI: 0.78–1.31, P = 0.939). These findings were unchanged when addressing measured confounding using propensity‐matched analyses (HR = 1.16, 95% CI: 0.81–1.65, P = 0.417) and inverse probability treatment weighted analyses (HR = 1.01, 95% CI: 0.77–1.33, P = 0.950); and unmeasured confounding using instrumental variable analyses (Δ = 0.9%, 95% CI: −2.5%, 4.3%, P = 0.958). There was no association with mortality and untreated LAD disease (HR = 0.92, 95% CI: 0.72–1.17, P = 0.482) and LCx disease (HR = 0.90, 95% CI: 0.74–1.10, P = 0.999). However, untreated proximal LAD disease (HR = 1.23, 95% CI: 1.06–1.51, P = 0.045) and RCA disease (HR = 1.36, 95% CI: 1.08–1.65, P = 0.007) was associated with increased mortality, particularly in patients with ST‐elevation acute coronary syndrome (STEACS).
Conclusions
In this study of unselected patients undergoing PCI, complete revascularization did not confer a mortality benefit. However, the presence of untreated proximal LAD and RCA disease was prognostic in patients with STEACS. Thus, complete revascularization may be considered in select patient groups with anatomical subsets of coronary disease. |
| doi_str_mv | 10.1002/ccd.27331 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1945214723</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2053563888</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3531-b9b9f2f82055d6e0feeee89e61d9ac7288efa2bc32eba2db58536b6a3921b76b3</originalsourceid><addsrcrecordid>eNp1kV1rFDEUhgex2Fq98A9IwBsFt83HJjPTu7JWLRS8qeDdkMmc2aZkkjEns8v65_xrzXZWBaG5SQgPz-G8b1G8YfSMUcrPjenOeCkEe1acMMn5ouTqx_PDm9VLdVy8RLynlNaK1y-KY17VSpRLelL8vr0DMsaw9gGTNQTt2tveGu0NkNAT600YRgcJSISNRjM5He0vnWzwRPuOTD5F0Ak6YkIMXsdd_tYpDDvSB-fC1vo1GSGaKWkPYcJ_nPUJ4gb83nVBLvc-7XZocT9YfSylJGMelAEkW5vuyDC5ZDeACI50FkEjvCqOeu0QXh_u0-L756vb1dfFzbcv16vLm4URUrBFW7d1z_uKUyk7BbSHfKoaFOtqbUpeVdBr3hrBodW8a2UlhWqVFjVnbalacVq8n705q58TYGoGiwacm5dqcsqSs2XJRUbf_Yfehynm1bDJ44VUoqqqTH2YKRMDYoS-GaMdciwNo82-1Sa32jy2mtm3B-PUDtD9Jf_UmIHzGdhaB7unTc1q9WlWPgAZeLHA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2053563888</pqid></control><display><type>article</type><title>The prognostic significance of incomplete revascularization and untreated coronary anatomy following percutaneous coronary intervention: An analysis of 6,755 patients with multivessel disease</title><source>Wiley Online Library Journals Frontfile Complete</source><creator>Iqbal, M. Bilal ; Smith, Robert D. ; Lane, Rebecca ; Patel, Niket ; Mattar, Wala ; Kabir, Tito ; Panoulas, Vasileios ; Mason, Mark ; Dalby, Miles C. ; Grocott‐Mason, Richard ; Ilsley, Charles D.</creator><creatorcontrib>Iqbal, M. Bilal ; Smith, Robert D. ; Lane, Rebecca ; Patel, Niket ; Mattar, Wala ; Kabir, Tito ; Panoulas, Vasileios ; Mason, Mark ; Dalby, Miles C. ; Grocott‐Mason, Richard ; Ilsley, Charles D. ; Harefield Cardiac Outcomes Group Investigators ; on behalf of the Harefield Cardiac Outcomes Group Investigators</creatorcontrib><description>Background
More than half of the patients undergoing percutaneous coronary intervention (PCI) have multivessel disease. Whether complete revascularization impacts long‐term mortality or whether selected patients or those with specific coronary anatomy benefit from complete revascularization is unclear.
Methods
A total of 14,452 patients underwent PCI between 2004 and 2015 at Harefield Hospital, UK. Of these, 7,076 patients had multivessel disease. We excluded 321 patients with left main‐stem stenosis ≥50%, with 6,755 patients included in the analysis (936 patients had complete revascularization).
Results
The unadjusted 3‐year mortality rates were lower with complete revascularization (10.8% vs 13.1%, P = 0.047). However, multivariable‐adjusted analyses indicated that complete revascularization was not independently associated with mortality (HR = 1.01, 95% CI: 0.78–1.31, P = 0.939). These findings were unchanged when addressing measured confounding using propensity‐matched analyses (HR = 1.16, 95% CI: 0.81–1.65, P = 0.417) and inverse probability treatment weighted analyses (HR = 1.01, 95% CI: 0.77–1.33, P = 0.950); and unmeasured confounding using instrumental variable analyses (Δ = 0.9%, 95% CI: −2.5%, 4.3%, P = 0.958). There was no association with mortality and untreated LAD disease (HR = 0.92, 95% CI: 0.72–1.17, P = 0.482) and LCx disease (HR = 0.90, 95% CI: 0.74–1.10, P = 0.999). However, untreated proximal LAD disease (HR = 1.23, 95% CI: 1.06–1.51, P = 0.045) and RCA disease (HR = 1.36, 95% CI: 1.08–1.65, P = 0.007) was associated with increased mortality, particularly in patients with ST‐elevation acute coronary syndrome (STEACS).
Conclusions
In this study of unselected patients undergoing PCI, complete revascularization did not confer a mortality benefit. However, the presence of untreated proximal LAD and RCA disease was prognostic in patients with STEACS. Thus, complete revascularization may be considered in select patient groups with anatomical subsets of coronary disease.</description><identifier>ISSN: 1522-1946</identifier><identifier>EISSN: 1522-726X</identifier><identifier>DOI: 10.1002/ccd.27331</identifier><identifier>PMID: 28963740</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Acute coronary syndromes ; all‐cause mortality ; Anatomy ; Angioplasty ; complete revascularization ; Heart diseases ; Mortality ; multivessel disease ; Patients ; Stenosis ; Stents</subject><ispartof>Catheterization and cardiovascular interventions, 2018-06, Vol.91 (7), p.1229-1239</ispartof><rights>2017 Wiley Periodicals, Inc.</rights><rights>2018 Wiley Periodicals, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3531-b9b9f2f82055d6e0feeee89e61d9ac7288efa2bc32eba2db58536b6a3921b76b3</citedby><cites>FETCH-LOGICAL-c3531-b9b9f2f82055d6e0feeee89e61d9ac7288efa2bc32eba2db58536b6a3921b76b3</cites><orcidid>0000-0002-7864-7782</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fccd.27331$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fccd.27331$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,777,781,1412,27905,27906,45555,45556</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28963740$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Iqbal, M. Bilal</creatorcontrib><creatorcontrib>Smith, Robert D.</creatorcontrib><creatorcontrib>Lane, Rebecca</creatorcontrib><creatorcontrib>Patel, Niket</creatorcontrib><creatorcontrib>Mattar, Wala</creatorcontrib><creatorcontrib>Kabir, Tito</creatorcontrib><creatorcontrib>Panoulas, Vasileios</creatorcontrib><creatorcontrib>Mason, Mark</creatorcontrib><creatorcontrib>Dalby, Miles C.</creatorcontrib><creatorcontrib>Grocott‐Mason, Richard</creatorcontrib><creatorcontrib>Ilsley, Charles D.</creatorcontrib><creatorcontrib>Harefield Cardiac Outcomes Group Investigators</creatorcontrib><creatorcontrib>on behalf of the Harefield Cardiac Outcomes Group Investigators</creatorcontrib><title>The prognostic significance of incomplete revascularization and untreated coronary anatomy following percutaneous coronary intervention: An analysis of 6,755 patients with multivessel disease</title><title>Catheterization and cardiovascular interventions</title><addtitle>Catheter Cardiovasc Interv</addtitle><description>Background
More than half of the patients undergoing percutaneous coronary intervention (PCI) have multivessel disease. Whether complete revascularization impacts long‐term mortality or whether selected patients or those with specific coronary anatomy benefit from complete revascularization is unclear.
Methods
A total of 14,452 patients underwent PCI between 2004 and 2015 at Harefield Hospital, UK. Of these, 7,076 patients had multivessel disease. We excluded 321 patients with left main‐stem stenosis ≥50%, with 6,755 patients included in the analysis (936 patients had complete revascularization).
Results
The unadjusted 3‐year mortality rates were lower with complete revascularization (10.8% vs 13.1%, P = 0.047). However, multivariable‐adjusted analyses indicated that complete revascularization was not independently associated with mortality (HR = 1.01, 95% CI: 0.78–1.31, P = 0.939). These findings were unchanged when addressing measured confounding using propensity‐matched analyses (HR = 1.16, 95% CI: 0.81–1.65, P = 0.417) and inverse probability treatment weighted analyses (HR = 1.01, 95% CI: 0.77–1.33, P = 0.950); and unmeasured confounding using instrumental variable analyses (Δ = 0.9%, 95% CI: −2.5%, 4.3%, P = 0.958). There was no association with mortality and untreated LAD disease (HR = 0.92, 95% CI: 0.72–1.17, P = 0.482) and LCx disease (HR = 0.90, 95% CI: 0.74–1.10, P = 0.999). However, untreated proximal LAD disease (HR = 1.23, 95% CI: 1.06–1.51, P = 0.045) and RCA disease (HR = 1.36, 95% CI: 1.08–1.65, P = 0.007) was associated with increased mortality, particularly in patients with ST‐elevation acute coronary syndrome (STEACS).
Conclusions
In this study of unselected patients undergoing PCI, complete revascularization did not confer a mortality benefit. However, the presence of untreated proximal LAD and RCA disease was prognostic in patients with STEACS. Thus, complete revascularization may be considered in select patient groups with anatomical subsets of coronary disease.</description><subject>Acute coronary syndromes</subject><subject>all‐cause mortality</subject><subject>Anatomy</subject><subject>Angioplasty</subject><subject>complete revascularization</subject><subject>Heart diseases</subject><subject>Mortality</subject><subject>multivessel disease</subject><subject>Patients</subject><subject>Stenosis</subject><subject>Stents</subject><issn>1522-1946</issn><issn>1522-726X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><recordid>eNp1kV1rFDEUhgex2Fq98A9IwBsFt83HJjPTu7JWLRS8qeDdkMmc2aZkkjEns8v65_xrzXZWBaG5SQgPz-G8b1G8YfSMUcrPjenOeCkEe1acMMn5ouTqx_PDm9VLdVy8RLynlNaK1y-KY17VSpRLelL8vr0DMsaw9gGTNQTt2tveGu0NkNAT600YRgcJSISNRjM5He0vnWzwRPuOTD5F0Ak6YkIMXsdd_tYpDDvSB-fC1vo1GSGaKWkPYcJ_nPUJ4gb83nVBLvc-7XZocT9YfSylJGMelAEkW5vuyDC5ZDeACI50FkEjvCqOeu0QXh_u0-L756vb1dfFzbcv16vLm4URUrBFW7d1z_uKUyk7BbSHfKoaFOtqbUpeVdBr3hrBodW8a2UlhWqVFjVnbalacVq8n705q58TYGoGiwacm5dqcsqSs2XJRUbf_Yfehynm1bDJ44VUoqqqTH2YKRMDYoS-GaMdciwNo82-1Sa32jy2mtm3B-PUDtD9Jf_UmIHzGdhaB7unTc1q9WlWPgAZeLHA</recordid><startdate>20180601</startdate><enddate>20180601</enddate><creator>Iqbal, M. Bilal</creator><creator>Smith, Robert D.</creator><creator>Lane, Rebecca</creator><creator>Patel, Niket</creator><creator>Mattar, Wala</creator><creator>Kabir, Tito</creator><creator>Panoulas, Vasileios</creator><creator>Mason, Mark</creator><creator>Dalby, Miles C.</creator><creator>Grocott‐Mason, Richard</creator><creator>Ilsley, Charles D.</creator><general>Wiley Subscription Services, Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-7864-7782</orcidid></search><sort><creationdate>20180601</creationdate><title>The prognostic significance of incomplete revascularization and untreated coronary anatomy following percutaneous coronary intervention: An analysis of 6,755 patients with multivessel disease</title><author>Iqbal, M. Bilal ; Smith, Robert D. ; Lane, Rebecca ; Patel, Niket ; Mattar, Wala ; Kabir, Tito ; Panoulas, Vasileios ; Mason, Mark ; Dalby, Miles C. ; Grocott‐Mason, Richard ; Ilsley, Charles D.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3531-b9b9f2f82055d6e0feeee89e61d9ac7288efa2bc32eba2db58536b6a3921b76b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Acute coronary syndromes</topic><topic>all‐cause mortality</topic><topic>Anatomy</topic><topic>Angioplasty</topic><topic>complete revascularization</topic><topic>Heart diseases</topic><topic>Mortality</topic><topic>multivessel disease</topic><topic>Patients</topic><topic>Stenosis</topic><topic>Stents</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Iqbal, M. Bilal</creatorcontrib><creatorcontrib>Smith, Robert D.</creatorcontrib><creatorcontrib>Lane, Rebecca</creatorcontrib><creatorcontrib>Patel, Niket</creatorcontrib><creatorcontrib>Mattar, Wala</creatorcontrib><creatorcontrib>Kabir, Tito</creatorcontrib><creatorcontrib>Panoulas, Vasileios</creatorcontrib><creatorcontrib>Mason, Mark</creatorcontrib><creatorcontrib>Dalby, Miles C.</creatorcontrib><creatorcontrib>Grocott‐Mason, Richard</creatorcontrib><creatorcontrib>Ilsley, Charles D.</creatorcontrib><creatorcontrib>Harefield Cardiac Outcomes Group Investigators</creatorcontrib><creatorcontrib>on behalf of the Harefield Cardiac Outcomes Group Investigators</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Catheterization and cardiovascular interventions</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Iqbal, M. Bilal</au><au>Smith, Robert D.</au><au>Lane, Rebecca</au><au>Patel, Niket</au><au>Mattar, Wala</au><au>Kabir, Tito</au><au>Panoulas, Vasileios</au><au>Mason, Mark</au><au>Dalby, Miles C.</au><au>Grocott‐Mason, Richard</au><au>Ilsley, Charles D.</au><aucorp>Harefield Cardiac Outcomes Group Investigators</aucorp><aucorp>on behalf of the Harefield Cardiac Outcomes Group Investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The prognostic significance of incomplete revascularization and untreated coronary anatomy following percutaneous coronary intervention: An analysis of 6,755 patients with multivessel disease</atitle><jtitle>Catheterization and cardiovascular interventions</jtitle><addtitle>Catheter Cardiovasc Interv</addtitle><date>2018-06-01</date><risdate>2018</risdate><volume>91</volume><issue>7</issue><spage>1229</spage><epage>1239</epage><pages>1229-1239</pages><issn>1522-1946</issn><eissn>1522-726X</eissn><abstract>Background
More than half of the patients undergoing percutaneous coronary intervention (PCI) have multivessel disease. Whether complete revascularization impacts long‐term mortality or whether selected patients or those with specific coronary anatomy benefit from complete revascularization is unclear.
Methods
A total of 14,452 patients underwent PCI between 2004 and 2015 at Harefield Hospital, UK. Of these, 7,076 patients had multivessel disease. We excluded 321 patients with left main‐stem stenosis ≥50%, with 6,755 patients included in the analysis (936 patients had complete revascularization).
Results
The unadjusted 3‐year mortality rates were lower with complete revascularization (10.8% vs 13.1%, P = 0.047). However, multivariable‐adjusted analyses indicated that complete revascularization was not independently associated with mortality (HR = 1.01, 95% CI: 0.78–1.31, P = 0.939). These findings were unchanged when addressing measured confounding using propensity‐matched analyses (HR = 1.16, 95% CI: 0.81–1.65, P = 0.417) and inverse probability treatment weighted analyses (HR = 1.01, 95% CI: 0.77–1.33, P = 0.950); and unmeasured confounding using instrumental variable analyses (Δ = 0.9%, 95% CI: −2.5%, 4.3%, P = 0.958). There was no association with mortality and untreated LAD disease (HR = 0.92, 95% CI: 0.72–1.17, P = 0.482) and LCx disease (HR = 0.90, 95% CI: 0.74–1.10, P = 0.999). However, untreated proximal LAD disease (HR = 1.23, 95% CI: 1.06–1.51, P = 0.045) and RCA disease (HR = 1.36, 95% CI: 1.08–1.65, P = 0.007) was associated with increased mortality, particularly in patients with ST‐elevation acute coronary syndrome (STEACS).
Conclusions
In this study of unselected patients undergoing PCI, complete revascularization did not confer a mortality benefit. However, the presence of untreated proximal LAD and RCA disease was prognostic in patients with STEACS. Thus, complete revascularization may be considered in select patient groups with anatomical subsets of coronary disease.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>28963740</pmid><doi>10.1002/ccd.27331</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0002-7864-7782</orcidid></addata></record> |
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| identifier | ISSN: 1522-1946 |
| ispartof | Catheterization and cardiovascular interventions, 2018-06, Vol.91 (7), p.1229-1239 |
| issn | 1522-1946 1522-726X |
| language | eng |
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| source | Wiley Online Library Journals Frontfile Complete |
| subjects | Acute coronary syndromes all‐cause mortality Anatomy Angioplasty complete revascularization Heart diseases Mortality multivessel disease Patients Stenosis Stents |
| title | The prognostic significance of incomplete revascularization and untreated coronary anatomy following percutaneous coronary intervention: An analysis of 6,755 patients with multivessel disease |
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