Complete revascularization optimizes patient outcomes in multivessel coronary artery disease: Data from the e‐Ultimaster registry
Objectives The aim of this analysis was to assess the effect of the coronary revascularization strategy during index admission on clinical outcomes among patients undergoing percutaneous coronary intervention (PCI) with multivessel coronary artery disease (MVD). Background The value of complete reva...
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| Veröffentlicht in: | Catheterization and cardiovascular interventions 2022-03, Vol.99 (4), p.961-967 |
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| creator | Williams, Timothy Mittal, Aaina Karageorgiev, Dimitar Iniguez Romo, Andres Aminian, Adel Fernandez Portalese, Javier Kharrat, Elyes Gómez‐Hospital, Joan Antoni Firman, Doni Trillo Nouche, Ramiro Hildick‐Smith, David |
| description | Objectives
The aim of this analysis was to assess the effect of the coronary revascularization strategy during index admission on clinical outcomes among patients undergoing percutaneous coronary intervention (PCI) with multivessel coronary artery disease (MVD).
Background
The value of complete revascularization (CR) over incomplete revascularization (IR) in MVD patients is not fully established.
Methods
Patients with MVD defined as ≥2 major epicardial vessels with ≥50% stenosis were selected from the observational all‐comer e‐Ultimaster registry. Patients were treated with a sirolimus‐eluting thin‐strut coronary stent. Completeness of revascularization was physician assessed at the index procedure or an eventually staged procedure during the index hospitalization. Outcomes measures at 1 year were target lesion failure (TLF) (composite of cardiac death, target vessel‐related myocardial infarction [MI], and clinically driven target lesion revascularization [TLR]), and patient‐oriented composite endpoint (POCE) (all‐cause mortality, MI, or revascularization). The inverse probability of treatment weights (IPTW) methodology was used to perform a matched analysis.
Results
The registry recruited 37,198 patients of whom 15,441 (41.5%) had MVD. CR on hospital discharge was achieved in 7413 (48.0%) patients and IR in 8028 (52.0%) patients. Mean age was 64.6 ± 11.1 versus 65.7 ± 11.0 years (p |
| doi_str_mv | 10.1002/ccd.30042 |
| format | Article |
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The aim of this analysis was to assess the effect of the coronary revascularization strategy during index admission on clinical outcomes among patients undergoing percutaneous coronary intervention (PCI) with multivessel coronary artery disease (MVD).
Background
The value of complete revascularization (CR) over incomplete revascularization (IR) in MVD patients is not fully established.
Methods
Patients with MVD defined as ≥2 major epicardial vessels with ≥50% stenosis were selected from the observational all‐comer e‐Ultimaster registry. Patients were treated with a sirolimus‐eluting thin‐strut coronary stent. Completeness of revascularization was physician assessed at the index procedure or an eventually staged procedure during the index hospitalization. Outcomes measures at 1 year were target lesion failure (TLF) (composite of cardiac death, target vessel‐related myocardial infarction [MI], and clinically driven target lesion revascularization [TLR]), and patient‐oriented composite endpoint (POCE) (all‐cause mortality, MI, or revascularization). The inverse probability of treatment weights (IPTW) methodology was used to perform a matched analysis.
Results
The registry recruited 37,198 patients of whom 15,441 (41.5%) had MVD. CR on hospital discharge was achieved in 7413 (48.0%) patients and IR in 8028 (52.0%) patients. Mean age was 64.6 ± 11.1 versus 65.7 ± 11.0 years (p < 0.01), male gender 77.9% and 77.3% (p = 0.41) and diabetes 31.3% versus 33.4% (p = 0.01) for CR and IR, respectively. Chronic stable angina patients more commonly underwent CR (47.6% vs. 36.8%, p < 0.01). After propensity weighted analysis, 90.5% of CR patients were angina‐free at 1 year compared with 87.5% of IR patients (p < 0.01). TLF (3.3% vs. 4.4%; p < 0.01), POCE (6.8% vs. 10.8%; p < .01), and all‐cause mortality (2.3% vs. 3.1%; p < .01) were all lower in CR patients.
Conclusions
A physician‐directed use of a CR strategy utilizing sirolimus‐eluting thin‐strut stent results in optimized clinical outcomes and less angina in an all‐comer population. Our findings suggest that a CR should be aimed for.]]></description><identifier>ISSN: 1522-1946</identifier><identifier>ISSN: 1522-726X</identifier><identifier>EISSN: 1522-726X</identifier><identifier>DOI: 10.1002/ccd.30042</identifier><identifier>PMID: 34962059</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Aged ; all‐comers ; Angina ; Angina pectoris ; Cardiovascular disease ; Clinical outcomes ; Coronary artery ; Coronary Artery Disease - diagnostic imaging ; Coronary Artery Disease - etiology ; Coronary Artery Disease - therapy ; Coronary vessels ; Diabetes mellitus ; Drug-Eluting Stents ; drug‐eluting stent ; Heart diseases ; Humans ; Implants ; Male ; Middle Aged ; Mortality ; multivessel disease ; Myocardial infarction ; Myocardial Infarction - etiology ; Patients ; Percutaneous Coronary Intervention ; Rapamycin ; Registries ; revascularization strategy ; Risk Factors ; Sirolimus - adverse effects ; Stenosis ; Stents ; Treatment Outcome ; Vein & artery diseases</subject><ispartof>Catheterization and cardiovascular interventions, 2022-03, Vol.99 (4), p.961-967</ispartof><rights>2021 The Authors. published by Wiley Periodicals LLC</rights><rights>2021 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.</rights><rights>2021. This article is published under http://creativecommons.org/licenses/by-nc/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3882-27f925b0666d7b580952f623421683a36f22f902cc99784226755e6bb97dd1543</citedby><cites>FETCH-LOGICAL-c3882-27f925b0666d7b580952f623421683a36f22f902cc99784226755e6bb97dd1543</cites><orcidid>0000-0002-9315-3529</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.30042$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fccd.30042$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34962059$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Williams, Timothy</creatorcontrib><creatorcontrib>Mittal, Aaina</creatorcontrib><creatorcontrib>Karageorgiev, Dimitar</creatorcontrib><creatorcontrib>Iniguez Romo, Andres</creatorcontrib><creatorcontrib>Aminian, Adel</creatorcontrib><creatorcontrib>Fernandez Portalese, Javier</creatorcontrib><creatorcontrib>Kharrat, Elyes</creatorcontrib><creatorcontrib>Gómez‐Hospital, Joan Antoni</creatorcontrib><creatorcontrib>Firman, Doni</creatorcontrib><creatorcontrib>Trillo Nouche, Ramiro</creatorcontrib><creatorcontrib>Hildick‐Smith, David</creatorcontrib><creatorcontrib>e-Ultimaster investigators</creatorcontrib><creatorcontrib>e‐Ultimaster investigators</creatorcontrib><title>Complete revascularization optimizes patient outcomes in multivessel coronary artery disease: Data from the e‐Ultimaster registry</title><title>Catheterization and cardiovascular interventions</title><addtitle>Catheter Cardiovasc Interv</addtitle><description><![CDATA[Objectives
The aim of this analysis was to assess the effect of the coronary revascularization strategy during index admission on clinical outcomes among patients undergoing percutaneous coronary intervention (PCI) with multivessel coronary artery disease (MVD).
Background
The value of complete revascularization (CR) over incomplete revascularization (IR) in MVD patients is not fully established.
Methods
Patients with MVD defined as ≥2 major epicardial vessels with ≥50% stenosis were selected from the observational all‐comer e‐Ultimaster registry. Patients were treated with a sirolimus‐eluting thin‐strut coronary stent. Completeness of revascularization was physician assessed at the index procedure or an eventually staged procedure during the index hospitalization. Outcomes measures at 1 year were target lesion failure (TLF) (composite of cardiac death, target vessel‐related myocardial infarction [MI], and clinically driven target lesion revascularization [TLR]), and patient‐oriented composite endpoint (POCE) (all‐cause mortality, MI, or revascularization). The inverse probability of treatment weights (IPTW) methodology was used to perform a matched analysis.
Results
The registry recruited 37,198 patients of whom 15,441 (41.5%) had MVD. CR on hospital discharge was achieved in 7413 (48.0%) patients and IR in 8028 (52.0%) patients. Mean age was 64.6 ± 11.1 versus 65.7 ± 11.0 years (p < 0.01), male gender 77.9% and 77.3% (p = 0.41) and diabetes 31.3% versus 33.4% (p = 0.01) for CR and IR, respectively. Chronic stable angina patients more commonly underwent CR (47.6% vs. 36.8%, p < 0.01). After propensity weighted analysis, 90.5% of CR patients were angina‐free at 1 year compared with 87.5% of IR patients (p < 0.01). TLF (3.3% vs. 4.4%; p < 0.01), POCE (6.8% vs. 10.8%; p < .01), and all‐cause mortality (2.3% vs. 3.1%; p < .01) were all lower in CR patients.
Conclusions
A physician‐directed use of a CR strategy utilizing sirolimus‐eluting thin‐strut stent results in optimized clinical outcomes and less angina in an all‐comer population. Our findings suggest that a CR should be aimed for.]]></description><subject>Aged</subject><subject>all‐comers</subject><subject>Angina</subject><subject>Angina pectoris</subject><subject>Cardiovascular disease</subject><subject>Clinical outcomes</subject><subject>Coronary artery</subject><subject>Coronary Artery Disease - diagnostic imaging</subject><subject>Coronary Artery Disease - etiology</subject><subject>Coronary Artery Disease - therapy</subject><subject>Coronary vessels</subject><subject>Diabetes mellitus</subject><subject>Drug-Eluting Stents</subject><subject>drug‐eluting stent</subject><subject>Heart diseases</subject><subject>Humans</subject><subject>Implants</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>multivessel disease</subject><subject>Myocardial infarction</subject><subject>Myocardial Infarction - etiology</subject><subject>Patients</subject><subject>Percutaneous Coronary Intervention</subject><subject>Rapamycin</subject><subject>Registries</subject><subject>revascularization strategy</subject><subject>Risk Factors</subject><subject>Sirolimus - adverse effects</subject><subject>Stenosis</subject><subject>Stents</subject><subject>Treatment Outcome</subject><subject>Vein & artery diseases</subject><issn>1522-1946</issn><issn>1522-726X</issn><issn>1522-726X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>WIN</sourceid><sourceid>EIF</sourceid><recordid>eNp1kcFO3TAQRa2KqlDaRX-gssSmXTywx7ETd4dCS5GQuilSd5HjTIpREqe2Q_VYIfUH-MZ-CS7vwaISq7kanbkzo0vIO84OOWNwZG13KBgr4AXZ4xJgVYL6sbPVXBdql7yO8YoxphXoV2RXFFkwqffIn9qP84AJacBrE-0ymOBuTHJ-on5ObnQ3GOmcGzgl6pdk_ZgbbqLjMiR3jTHiQK0PfjJhTU1ImEvnIpqIn-iJSYb2wY80XSLFv7d3F3lqNDFjeeNPF1NYvyEvezNEfLut--Tiy-fv9dfV-bfTs_r4fGVFVcEKyl6DbJlSqitbWTEtoVcgCuCqEkaoHqDXDKzVuqwKAFVKiaptddl1XBZin3zY-M7B_1owpmZ00eIwmAn9EhtQXHKmBeMZPfgPvfJLmPJ1mZIgeSkAMvVxQ9ngYwzYN3PIz4V1w1nzL5kmJ9M8JJPZ91vHpR2xeyIfo8jA0Qb47QZcP-_U1PXJxvIepTqZZQ</recordid><startdate>20220301</startdate><enddate>20220301</enddate><creator>Williams, Timothy</creator><creator>Mittal, Aaina</creator><creator>Karageorgiev, Dimitar</creator><creator>Iniguez Romo, Andres</creator><creator>Aminian, Adel</creator><creator>Fernandez Portalese, Javier</creator><creator>Kharrat, Elyes</creator><creator>Gómez‐Hospital, Joan Antoni</creator><creator>Firman, Doni</creator><creator>Trillo Nouche, Ramiro</creator><creator>Hildick‐Smith, David</creator><general>Wiley Subscription Services, Inc</general><scope>24P</scope><scope>WIN</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><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/0000-0002-9315-3529</orcidid></search><sort><creationdate>20220301</creationdate><title>Complete revascularization optimizes patient outcomes in multivessel coronary artery disease: Data from the e‐Ultimaster registry</title><author>Williams, Timothy ; Mittal, Aaina ; Karageorgiev, Dimitar ; Iniguez Romo, Andres ; Aminian, Adel ; Fernandez Portalese, Javier ; Kharrat, Elyes ; Gómez‐Hospital, Joan Antoni ; Firman, Doni ; Trillo Nouche, Ramiro ; Hildick‐Smith, David</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3882-27f925b0666d7b580952f623421683a36f22f902cc99784226755e6bb97dd1543</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Aged</topic><topic>all‐comers</topic><topic>Angina</topic><topic>Angina pectoris</topic><topic>Cardiovascular disease</topic><topic>Clinical outcomes</topic><topic>Coronary artery</topic><topic>Coronary Artery Disease - diagnostic imaging</topic><topic>Coronary Artery Disease - etiology</topic><topic>Coronary Artery Disease - therapy</topic><topic>Coronary vessels</topic><topic>Diabetes mellitus</topic><topic>Drug-Eluting Stents</topic><topic>drug‐eluting stent</topic><topic>Heart diseases</topic><topic>Humans</topic><topic>Implants</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>multivessel disease</topic><topic>Myocardial infarction</topic><topic>Myocardial Infarction - etiology</topic><topic>Patients</topic><topic>Percutaneous Coronary Intervention</topic><topic>Rapamycin</topic><topic>Registries</topic><topic>revascularization strategy</topic><topic>Risk Factors</topic><topic>Sirolimus - adverse effects</topic><topic>Stenosis</topic><topic>Stents</topic><topic>Treatment Outcome</topic><topic>Vein & artery diseases</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Williams, Timothy</creatorcontrib><creatorcontrib>Mittal, Aaina</creatorcontrib><creatorcontrib>Karageorgiev, Dimitar</creatorcontrib><creatorcontrib>Iniguez Romo, Andres</creatorcontrib><creatorcontrib>Aminian, Adel</creatorcontrib><creatorcontrib>Fernandez Portalese, Javier</creatorcontrib><creatorcontrib>Kharrat, Elyes</creatorcontrib><creatorcontrib>Gómez‐Hospital, Joan Antoni</creatorcontrib><creatorcontrib>Firman, Doni</creatorcontrib><creatorcontrib>Trillo Nouche, Ramiro</creatorcontrib><creatorcontrib>Hildick‐Smith, David</creatorcontrib><creatorcontrib>e-Ultimaster investigators</creatorcontrib><creatorcontrib>e‐Ultimaster investigators</creatorcontrib><collection>Wiley-Blackwell Open Access Titles</collection><collection>Wiley Free Content</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><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>Williams, Timothy</au><au>Mittal, Aaina</au><au>Karageorgiev, Dimitar</au><au>Iniguez Romo, Andres</au><au>Aminian, Adel</au><au>Fernandez Portalese, Javier</au><au>Kharrat, Elyes</au><au>Gómez‐Hospital, Joan Antoni</au><au>Firman, Doni</au><au>Trillo Nouche, Ramiro</au><au>Hildick‐Smith, David</au><aucorp>e-Ultimaster investigators</aucorp><aucorp>e‐Ultimaster investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Complete revascularization optimizes patient outcomes in multivessel coronary artery disease: Data from the e‐Ultimaster registry</atitle><jtitle>Catheterization and cardiovascular interventions</jtitle><addtitle>Catheter Cardiovasc Interv</addtitle><date>2022-03-01</date><risdate>2022</risdate><volume>99</volume><issue>4</issue><spage>961</spage><epage>967</epage><pages>961-967</pages><issn>1522-1946</issn><issn>1522-726X</issn><eissn>1522-726X</eissn><abstract><![CDATA[Objectives
The aim of this analysis was to assess the effect of the coronary revascularization strategy during index admission on clinical outcomes among patients undergoing percutaneous coronary intervention (PCI) with multivessel coronary artery disease (MVD).
Background
The value of complete revascularization (CR) over incomplete revascularization (IR) in MVD patients is not fully established.
Methods
Patients with MVD defined as ≥2 major epicardial vessels with ≥50% stenosis were selected from the observational all‐comer e‐Ultimaster registry. Patients were treated with a sirolimus‐eluting thin‐strut coronary stent. Completeness of revascularization was physician assessed at the index procedure or an eventually staged procedure during the index hospitalization. Outcomes measures at 1 year were target lesion failure (TLF) (composite of cardiac death, target vessel‐related myocardial infarction [MI], and clinically driven target lesion revascularization [TLR]), and patient‐oriented composite endpoint (POCE) (all‐cause mortality, MI, or revascularization). The inverse probability of treatment weights (IPTW) methodology was used to perform a matched analysis.
Results
The registry recruited 37,198 patients of whom 15,441 (41.5%) had MVD. CR on hospital discharge was achieved in 7413 (48.0%) patients and IR in 8028 (52.0%) patients. Mean age was 64.6 ± 11.1 versus 65.7 ± 11.0 years (p < 0.01), male gender 77.9% and 77.3% (p = 0.41) and diabetes 31.3% versus 33.4% (p = 0.01) for CR and IR, respectively. Chronic stable angina patients more commonly underwent CR (47.6% vs. 36.8%, p < 0.01). After propensity weighted analysis, 90.5% of CR patients were angina‐free at 1 year compared with 87.5% of IR patients (p < 0.01). TLF (3.3% vs. 4.4%; p < 0.01), POCE (6.8% vs. 10.8%; p < .01), and all‐cause mortality (2.3% vs. 3.1%; p < .01) were all lower in CR patients.
Conclusions
A physician‐directed use of a CR strategy utilizing sirolimus‐eluting thin‐strut stent results in optimized clinical outcomes and less angina in an all‐comer population. Our findings suggest that a CR should be aimed for.]]></abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>34962059</pmid><doi>10.1002/ccd.30042</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-9315-3529</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
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| ispartof | Catheterization and cardiovascular interventions, 2022-03, Vol.99 (4), p.961-967 |
| issn | 1522-1946 1522-726X 1522-726X |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2615109301 |
| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Aged all‐comers Angina Angina pectoris Cardiovascular disease Clinical outcomes Coronary artery Coronary Artery Disease - diagnostic imaging Coronary Artery Disease - etiology Coronary Artery Disease - therapy Coronary vessels Diabetes mellitus Drug-Eluting Stents drug‐eluting stent Heart diseases Humans Implants Male Middle Aged Mortality multivessel disease Myocardial infarction Myocardial Infarction - etiology Patients Percutaneous Coronary Intervention Rapamycin Registries revascularization strategy Risk Factors Sirolimus - adverse effects Stenosis Stents Treatment Outcome Vein & artery diseases |
| title | Complete revascularization optimizes patient outcomes in multivessel coronary artery disease: Data from the e‐Ultimaster registry |
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