Multivessel disease: patient stratification and treatment

Jose Luis Pomar and Jean Fajadet chaired an important session for those treating patients with multivessel disease (MVD). To do this properly we must develop both a patient stratification and treatment strategy, otherwise we are putting lives at risk.

The question is, how can we best make use of MVD data, to influence patient outcomes and make better choices? We must streamline our approach to decision making in the following manner: Knowledge from randomised trials and registries must be used but not alone. We should perform a global appraisal of the patient and not just concentrate on the affected vessels. We should consider the experience not just of the operator but also the centre in general and finally, we must consider that technology is constantly evolving and that while we may be using a DES today, we will one day be using polymer-free and totally bioabsorbable stents.

Dogma has stated that complete revascularisation is necessary, based on several reports showing that the clinical outcome was better. However, with the use of FFR and the results of the FAME trial, the concept of functionally complete revascularisation states that we stent ischaemic lesions and leave nonischaemic lesions for medical therapy. Antonio Colombo and Nico Pijls debated the value of anatomical versus functional revascularisation, respectively.

Scot Garg asked whether scoring systems are practical in daily practice. The second debate of the session was between Laura Mauri and Friedhelm Beyersdorf who discussed what data matters for MVD revascularisation from the interventionalists’ and surgeons’ perspectives, respectively. Isabelle Durand Zaleski discussed quantity versus quality of life following MVD treatment. The session made use of two live transmissions from Bad Soden and one from London. So should we be using PCI to treat MVD?

Click here to read the full article and access the slides!

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