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Expert review

Clinical outcomes based on completeness of revascularisation in patients undergoing percutaneous coronary intervention: a meta-analysis of multivessel coronary artery disease studies

1. Department of Medicine, Jacobi Medical Center, Bronx, NY, USA; 2. Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA; 3. Department of Medicine, Bronx-Lebanon Hospital, Bronx, NY, USA; 4. Division of Cardiology, Department of Medicine, Montefiore Medical Center, Bronx, NY, USA

Aims: Most studies investigating completeness of revascularisation and outcomes for multivessel disease (MVD) patients are limited by small sample size.

Methods and results: We searched PUBMED, Cochrane and EMBASE for studies comparing outcomes of MVD patients with complete revascularisation (CR) vs. incomplete revascularisation (IR) in the stent era. We identified nine studies that met our selection criteria. Compared to IR, patients undergoing CR had significantly lower risk of mortality (relative risk (RR): 0.82; 95% confidence interval (CI): 0.68-0.99; p=0.05), non-fatal myocardial infarction (MI) (RR: 0.67; 95% CI: 0.53-0.84; p <0.01) and subsequent coronary artery bypass graft surgery (CABG) (RR: 0.70; 95% CI: 0.52-0.95; p=0.02) whereas no difference was noted in the incidence of repeat percutaneous coronary intervention (PCI) (RR: 0.87; 95% CI: 0.69-1.11; p=0.28). Average weighted follow up was approximately 29 months for mortality, subsequent CABG and Repeat PCI whereas it was 19 months for non-fatal MI. The results were similar after excluding the only RCT or the one study restricted to diabetics or the study restricted to drug-eluting stent use.

Conclusions: In patients with multivessel coronary disease, complete revascularisation with PCI may be associated with better outcomes than incomplete revascularisation.

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