Long-term Efficacy Of Complete Versus Incomplete Revascularization In Patients With Multivessel Coronary Artery Disease

Background and aims:Recent randomized control trials(RCT)had indicated better clinical outcomes of complete revascularization(CR)for multivessel disease(MVD)patients,which was contradict to previous large-scale observational studies.Whether CR was associated with better prognosis in patients with multivessel coronary artery disease remained controversial.This single-center,retrospective study was designed to compare long-term clinical efficacy of complete versus incomplete revascularization(IR)for all-comers with MVD.Methods:We enrolled all consecutive CAD patients with MVD who underwent percutaneous coronary intervention(PCI)and drug-eluting stents(DES)implantation during January 2015 to December 2015.CR was performed either index or staged procedure.The primary endpoint was major adverse cardiovascular events(MACE)including cardiac death,non-fatal myocardial infarction(MI),stent thrombosis(ST),and target lesion revascularization(TLR).Secondary endpoints were defined as specific adverse events during follow-up.Analysis was on an intention-to-treat basis.Results:A total of 578 patients were enrolled in present the study,of whom 191 were subjected to IR and the other 387 were subjected to CR.Baseline clinical and angiographic characteristics were generally comparable between two intervention groups.During follow-up periods,CR was associated with lower rates of MACE(3.7%vs 12.8%;p<0.001),which was mainly contributed by the reduction of cardiac death(0.5%vs 3.2%;p=0.011)and TLR(3.1%vs 9.6%;p=0.001).Other secondary endpoints including MI(0.0%vs 1.6%;p=0.013),ST(0.0%vs 1.6%;p=0.013),TVR(3.7%vs 11.2%;p<0.001),and non-TVR(5.2%vs 13.3%;p=0.001)were also decreased markedly in CR group.Multivariate Cox regression analyses showed that CR was an independent protective predictor for MACE(HR:0.261;95%CI:0.124-0.551;p<0.001).Conclusion:In patients undergoing stents implantation with MVD,CR was associated with lower rates of MACE,cardiac death,MI,ST,TLR,TVR,and non-TVR.Thus,for CAD patients with mutivessel disease,CR might be recommended as preferable strategy.