Researchers, led by Timothy Williams, MD, from the Sussex Cardiac Centre at the Brighton and Sussex University Hospitals, examined the impact of the coronary revascularization strategy during admission on outcomes in patients with multivessel coronary artery disease (MVD) undergoing percutaneous coronary intervention (PCI). Their report, published in Catherization and Cardiovascular Interventions, found that a physician-directed CR strategy including sirolimus-eluting thing-strut stents appeared to result in more optimal clinical outcomes and less angina.
According to Dr. Williams, “Our findings suggest that a CR should be aimed for.” The researchers investigated 15,441 patients with MVD, defined as two or more major epicardial vessels with ≥50% stenosis, from the observational all-comer e-Ultimaster registry. The degree of revascularization achieved was assessed by a physician at the index procedure or a later procedure during hospitalization. The primary outcomes were complete revascularizations (CR), incomplete revascularizations (IR), target lesion failure (TLF), and patient-oriented composite outcome (POCE).
At hospital discharge, 7,413 patients achieved CR and 8,028 achieved IR. According to the investigators, patients with chronic stable angina more commonly reached CR (47.6% vs. 36.8%, p <0.01). After deeper analysis, the authors reported that 90.5% of patients with CR were angina-free at one year. Comparatively, 87.5% of patients with IR were angina-free at one year (p <0.01). TLF, POCE, and all-cause mortality were all lower in patients who achieved CR (p <0.01).
The study’s authors stated that they established the value of complete revascularization, and suggested that physicians aim to achieve CR during care of patients with MVD.