Incidence, predictors and outcomes of incomplete revascularization after percutaneous coronary intervention and coronary artery bypass grafting: a subgroup analysis of 3-year SYNTAX data
OBJECTIVE To assess whether incomplete revascularization by percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) has an effect on long-term outcomes. METHODS During a heart team discussion to evaluate whether patients were eligible for randomization in the SYNTAX trial,...
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| Veröffentlicht in: | European journal of cardio-thoracic surgery 2012-03, Vol.41 (3), p.535-541 |
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| creator | Head, Stuart J. Mack, Michael J. Holmes, David R. Mohr, Friedrich W. Morice, Marie-Claude Serruys, Patrick W. Kappetein, A. Pieter |
| description | OBJECTIVE
To assess whether incomplete revascularization by percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) has an effect on long-term outcomes.
METHODS
During a heart team discussion to evaluate whether patients were eligible for randomization in the SYNTAX trial, both the cardiologist and surgeon agreed on which vessels needed revascularization. This statement was compared with the actual revascularization after treatment. Incomplete revascularization was defined as when a preoperatively identified vessel with a lesion was not revascularized. Outcomes were major adverse cardiac or cerebrovascular events (MACCE), the composite safety endpoint of death/stroke/myocardial infarction (MI), and individual MACCE components death, MI and repeat revascularization at 3 years. Predictors of incomplete revascularization were explored.
RESULTS
Incomplete revascularization was found in 43.3% (388/896) PCI and 36.8% (320/870) CABG patients. Patients with complete revascularization by PCI had lower rates of MACCE (66.5 versus 76.2%, P < 0.001), the composite safety endpoint (83.4 versus 87.9%, P = 0.05) and repeat revascularization (75.5 versus 83.9%, P < 0.001), but not death and MI. In the CABG group, no difference in outcomes was seen between incomplete and complete revascularization groups. Incomplete revascularization was identified as independent predictor of MACCE in PCI (HR = 1.55, 95% CI 1.15-2.08, P = 0.004) but not CABG patients. Independent predictors of incomplete revascularization by PCI were hyperlipidaemia (OR = 1.59, 95% CI 1.04-2.42, P = 0.031), a total occlusion (OR = 2.46, 95% CI 1.66-3.64, P < 0.001) and the number of vessels (OR = 1.58, 95% CI 1.41-1.77, P < 0.001). Independent predictors of incomplete revascularization by CABG were unstable angina (OR = 1.42, 95% CI 1.02-1.98, P = 0.038), diffuse disease or narrowed ( < 2 mm) segment distal to the lesion (OR = 1.87, 95% CI 1.31-2.69, P = 0.001) and the number of vessels (OR = 1.70, 95% CI 1.53-1.89, P < 0.001).
CONCLUSIONS
Despite the hypothesis-generating nature of this data, this study demonstrates that incomplete revascularization is associated with adverse events during follow-up after PCI but not CABG. |
| doi_str_mv | 10.1093/ejcts/ezr105 |
| format | Article |
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To assess whether incomplete revascularization by percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) has an effect on long-term outcomes.
METHODS
During a heart team discussion to evaluate whether patients were eligible for randomization in the SYNTAX trial, both the cardiologist and surgeon agreed on which vessels needed revascularization. This statement was compared with the actual revascularization after treatment. Incomplete revascularization was defined as when a preoperatively identified vessel with a lesion was not revascularized. Outcomes were major adverse cardiac or cerebrovascular events (MACCE), the composite safety endpoint of death/stroke/myocardial infarction (MI), and individual MACCE components death, MI and repeat revascularization at 3 years. Predictors of incomplete revascularization were explored.
RESULTS
Incomplete revascularization was found in 43.3% (388/896) PCI and 36.8% (320/870) CABG patients. Patients with complete revascularization by PCI had lower rates of MACCE (66.5 versus 76.2%, P < 0.001), the composite safety endpoint (83.4 versus 87.9%, P = 0.05) and repeat revascularization (75.5 versus 83.9%, P < 0.001), but not death and MI. In the CABG group, no difference in outcomes was seen between incomplete and complete revascularization groups. Incomplete revascularization was identified as independent predictor of MACCE in PCI (HR = 1.55, 95% CI 1.15-2.08, P = 0.004) but not CABG patients. Independent predictors of incomplete revascularization by PCI were hyperlipidaemia (OR = 1.59, 95% CI 1.04-2.42, P = 0.031), a total occlusion (OR = 2.46, 95% CI 1.66-3.64, P < 0.001) and the number of vessels (OR = 1.58, 95% CI 1.41-1.77, P < 0.001). Independent predictors of incomplete revascularization by CABG were unstable angina (OR = 1.42, 95% CI 1.02-1.98, P = 0.038), diffuse disease or narrowed ( < 2 mm) segment distal to the lesion (OR = 1.87, 95% CI 1.31-2.69, P = 0.001) and the number of vessels (OR = 1.70, 95% CI 1.53-1.89, P < 0.001).
CONCLUSIONS
Despite the hypothesis-generating nature of this data, this study demonstrates that incomplete revascularization is associated with adverse events during follow-up after PCI but not CABG.]]></description><identifier>ISSN: 1010-7940</identifier><identifier>EISSN: 1873-734X</identifier><identifier>DOI: 10.1093/ejcts/ezr105</identifier><identifier>PMID: 22219412</identifier><identifier>CODEN: EJCSE7</identifier><language>eng</language><publisher>Oxford: Oxford University Press</publisher><subject>Aged ; Angioplasty, Balloon, Coronary - adverse effects ; Biological and medical sciences ; Cardiology. Vascular system ; Cardiovascular Diseases - etiology ; Coronary Artery Bypass - adverse effects ; Coronary Artery Disease - pathology ; Coronary Artery Disease - surgery ; Coronary Artery Disease - therapy ; Coronary heart disease ; Diseases of the cardiovascular system ; Drug-Eluting Stents ; Female ; Follow-Up Studies ; Heart ; Humans ; Male ; Medical sciences ; Middle Aged ; Pneumology ; Prognosis ; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) ; Reoperation - statistics & numerical data ; Risk Factors ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the heart ; Treatment Outcome</subject><ispartof>European journal of cardio-thoracic surgery, 2012-03, Vol.41 (3), p.535-541</ispartof><rights>The Author 2011. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. 2011</rights><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c456t-af2f1bad8193a788ad7019b6725c0ead94d14f3f5503c6513631466b4edfe8d63</citedby><cites>FETCH-LOGICAL-c456t-af2f1bad8193a788ad7019b6725c0ead94d14f3f5503c6513631466b4edfe8d63</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,1578,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=25668815$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22219412$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Head, Stuart J.</creatorcontrib><creatorcontrib>Mack, Michael J.</creatorcontrib><creatorcontrib>Holmes, David R.</creatorcontrib><creatorcontrib>Mohr, Friedrich W.</creatorcontrib><creatorcontrib>Morice, Marie-Claude</creatorcontrib><creatorcontrib>Serruys, Patrick W.</creatorcontrib><creatorcontrib>Kappetein, A. Pieter</creatorcontrib><title>Incidence, predictors and outcomes of incomplete revascularization after percutaneous coronary intervention and coronary artery bypass grafting: a subgroup analysis of 3-year SYNTAX data</title><title>European journal of cardio-thoracic surgery</title><addtitle>Eur J Cardiothorac Surg</addtitle><description><![CDATA[OBJECTIVE
To assess whether incomplete revascularization by percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) has an effect on long-term outcomes.
METHODS
During a heart team discussion to evaluate whether patients were eligible for randomization in the SYNTAX trial, both the cardiologist and surgeon agreed on which vessels needed revascularization. This statement was compared with the actual revascularization after treatment. Incomplete revascularization was defined as when a preoperatively identified vessel with a lesion was not revascularized. Outcomes were major adverse cardiac or cerebrovascular events (MACCE), the composite safety endpoint of death/stroke/myocardial infarction (MI), and individual MACCE components death, MI and repeat revascularization at 3 years. Predictors of incomplete revascularization were explored.
RESULTS
Incomplete revascularization was found in 43.3% (388/896) PCI and 36.8% (320/870) CABG patients. Patients with complete revascularization by PCI had lower rates of MACCE (66.5 versus 76.2%, P < 0.001), the composite safety endpoint (83.4 versus 87.9%, P = 0.05) and repeat revascularization (75.5 versus 83.9%, P < 0.001), but not death and MI. In the CABG group, no difference in outcomes was seen between incomplete and complete revascularization groups. Incomplete revascularization was identified as independent predictor of MACCE in PCI (HR = 1.55, 95% CI 1.15-2.08, P = 0.004) but not CABG patients. Independent predictors of incomplete revascularization by PCI were hyperlipidaemia (OR = 1.59, 95% CI 1.04-2.42, P = 0.031), a total occlusion (OR = 2.46, 95% CI 1.66-3.64, P < 0.001) and the number of vessels (OR = 1.58, 95% CI 1.41-1.77, P < 0.001). Independent predictors of incomplete revascularization by CABG were unstable angina (OR = 1.42, 95% CI 1.02-1.98, P = 0.038), diffuse disease or narrowed ( < 2 mm) segment distal to the lesion (OR = 1.87, 95% CI 1.31-2.69, P = 0.001) and the number of vessels (OR = 1.70, 95% CI 1.53-1.89, P < 0.001).
CONCLUSIONS
Despite the hypothesis-generating nature of this data, this study demonstrates that incomplete revascularization is associated with adverse events during follow-up after PCI but not CABG.]]></description><subject>Aged</subject><subject>Angioplasty, Balloon, Coronary - adverse effects</subject><subject>Biological and medical sciences</subject><subject>Cardiology. Vascular system</subject><subject>Cardiovascular Diseases - etiology</subject><subject>Coronary Artery Bypass - adverse effects</subject><subject>Coronary Artery Disease - pathology</subject><subject>Coronary Artery Disease - surgery</subject><subject>Coronary Artery Disease - therapy</subject><subject>Coronary heart disease</subject><subject>Diseases of the cardiovascular system</subject><subject>Drug-Eluting Stents</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Heart</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Pneumology</subject><subject>Prognosis</subject><subject>Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)</subject><subject>Reoperation - statistics & numerical data</subject><subject>Risk Factors</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the heart</subject><subject>Treatment Outcome</subject><issn>1010-7940</issn><issn>1873-734X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc1O3TAQhaOqVaG0u64rb6puSPFP7CTdIdQCEiqLUomuook9vjLKjVPbQQqPxtNhyC3suvJI55vjmTlF8ZHRr4y24ghvdIpHeBcYla-KfdbUoqxFdf0615TRsm4rule8i_GGUqoEr98We5xz1laM7xf356N2BkeNh2QKaJxOPkQCoyF-TtpvMRJviRtzOQ2YkAS8hajnAYK7g-T8SMAmDGTCoOcEI_o5Eu2DHyEsuTFrtziuYHZ9ViBkZSH9MkGMZBOyixs33wiQOPeb4Ocp8zAs0T1NIMoFIZBff35eHV8TAwneF28sDBE_7N6D4veP71cnZ-XF5en5yfFFqSupUgmWW9aDaVgroG4aMDVlba9qLjVFMG1lWGWFlZIKrSQTSrBKqb5CY7ExShwUX1bfKfi_M8bUbV3UOAzrrl3LuaQ1VTyThyupg48xoO2m4LZ52Y7R7jGs7imsbg0r4592xnO_RfMM_0snA593QL44DDZADiu-cFKppmHyZcJ8tP9_-QAh57Gi</recordid><startdate>20120301</startdate><enddate>20120301</enddate><creator>Head, Stuart J.</creator><creator>Mack, Michael J.</creator><creator>Holmes, David R.</creator><creator>Mohr, Friedrich W.</creator><creator>Morice, Marie-Claude</creator><creator>Serruys, Patrick W.</creator><creator>Kappetein, A. Pieter</creator><general>Oxford University Press</general><scope>IQODW</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>7X8</scope></search><sort><creationdate>20120301</creationdate><title>Incidence, predictors and outcomes of incomplete revascularization after percutaneous coronary intervention and coronary artery bypass grafting: a subgroup analysis of 3-year SYNTAX data</title><author>Head, Stuart J. ; Mack, Michael J. ; Holmes, David R. ; Mohr, Friedrich W. ; Morice, Marie-Claude ; Serruys, Patrick W. ; Kappetein, A. Pieter</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c456t-af2f1bad8193a788ad7019b6725c0ead94d14f3f5503c6513631466b4edfe8d63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Aged</topic><topic>Angioplasty, Balloon, Coronary - adverse effects</topic><topic>Biological and medical sciences</topic><topic>Cardiology. Vascular system</topic><topic>Cardiovascular Diseases - etiology</topic><topic>Coronary Artery Bypass - adverse effects</topic><topic>Coronary Artery Disease - pathology</topic><topic>Coronary Artery Disease - surgery</topic><topic>Coronary Artery Disease - therapy</topic><topic>Coronary heart disease</topic><topic>Diseases of the cardiovascular system</topic><topic>Drug-Eluting Stents</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Heart</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Pneumology</topic><topic>Prognosis</topic><topic>Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)</topic><topic>Reoperation - statistics & numerical data</topic><topic>Risk Factors</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the heart</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Head, Stuart J.</creatorcontrib><creatorcontrib>Mack, Michael J.</creatorcontrib><creatorcontrib>Holmes, David R.</creatorcontrib><creatorcontrib>Mohr, Friedrich W.</creatorcontrib><creatorcontrib>Morice, Marie-Claude</creatorcontrib><creatorcontrib>Serruys, Patrick W.</creatorcontrib><creatorcontrib>Kappetein, A. Pieter</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of cardio-thoracic surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Head, Stuart J.</au><au>Mack, Michael J.</au><au>Holmes, David R.</au><au>Mohr, Friedrich W.</au><au>Morice, Marie-Claude</au><au>Serruys, Patrick W.</au><au>Kappetein, A. Pieter</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Incidence, predictors and outcomes of incomplete revascularization after percutaneous coronary intervention and coronary artery bypass grafting: a subgroup analysis of 3-year SYNTAX data</atitle><jtitle>European journal of cardio-thoracic surgery</jtitle><addtitle>Eur J Cardiothorac Surg</addtitle><date>2012-03-01</date><risdate>2012</risdate><volume>41</volume><issue>3</issue><spage>535</spage><epage>541</epage><pages>535-541</pages><issn>1010-7940</issn><eissn>1873-734X</eissn><coden>EJCSE7</coden><abstract><![CDATA[OBJECTIVE
To assess whether incomplete revascularization by percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) has an effect on long-term outcomes.
METHODS
During a heart team discussion to evaluate whether patients were eligible for randomization in the SYNTAX trial, both the cardiologist and surgeon agreed on which vessels needed revascularization. This statement was compared with the actual revascularization after treatment. Incomplete revascularization was defined as when a preoperatively identified vessel with a lesion was not revascularized. Outcomes were major adverse cardiac or cerebrovascular events (MACCE), the composite safety endpoint of death/stroke/myocardial infarction (MI), and individual MACCE components death, MI and repeat revascularization at 3 years. Predictors of incomplete revascularization were explored.
RESULTS
Incomplete revascularization was found in 43.3% (388/896) PCI and 36.8% (320/870) CABG patients. Patients with complete revascularization by PCI had lower rates of MACCE (66.5 versus 76.2%, P < 0.001), the composite safety endpoint (83.4 versus 87.9%, P = 0.05) and repeat revascularization (75.5 versus 83.9%, P < 0.001), but not death and MI. In the CABG group, no difference in outcomes was seen between incomplete and complete revascularization groups. Incomplete revascularization was identified as independent predictor of MACCE in PCI (HR = 1.55, 95% CI 1.15-2.08, P = 0.004) but not CABG patients. Independent predictors of incomplete revascularization by PCI were hyperlipidaemia (OR = 1.59, 95% CI 1.04-2.42, P = 0.031), a total occlusion (OR = 2.46, 95% CI 1.66-3.64, P < 0.001) and the number of vessels (OR = 1.58, 95% CI 1.41-1.77, P < 0.001). Independent predictors of incomplete revascularization by CABG were unstable angina (OR = 1.42, 95% CI 1.02-1.98, P = 0.038), diffuse disease or narrowed ( < 2 mm) segment distal to the lesion (OR = 1.87, 95% CI 1.31-2.69, P = 0.001) and the number of vessels (OR = 1.70, 95% CI 1.53-1.89, P < 0.001).
CONCLUSIONS
Despite the hypothesis-generating nature of this data, this study demonstrates that incomplete revascularization is associated with adverse events during follow-up after PCI but not CABG.]]></abstract><cop>Oxford</cop><pub>Oxford University Press</pub><pmid>22219412</pmid><doi>10.1093/ejcts/ezr105</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Angioplasty, Balloon, Coronary - adverse effects Biological and medical sciences Cardiology. Vascular system Cardiovascular Diseases - etiology Coronary Artery Bypass - adverse effects Coronary Artery Disease - pathology Coronary Artery Disease - surgery Coronary Artery Disease - therapy Coronary heart disease Diseases of the cardiovascular system Drug-Eluting Stents Female Follow-Up Studies Heart Humans Male Medical sciences Middle Aged Pneumology Prognosis Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) Reoperation - statistics & numerical data Risk Factors Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the heart Treatment Outcome |
| title | Incidence, predictors and outcomes of incomplete revascularization after percutaneous coronary intervention and coronary artery bypass grafting: a subgroup analysis of 3-year SYNTAX data |
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