McLellan CS, Ghali WA, Labinaz M, Davis R, Galbraith D, Southern D, Shrive F, Knudtson ML, for the APPROACH Investigators. Association between completeness of percutaneous coronary revascularization and post-procedure outcomes. Am Heart J 2005 Oct; 150(4):800-806.
Background: Multivessel coronary artery revascularization may be accomplished by percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG). The importance of complete revascularization is emphasized in the surgical literature, but little is known about its impact on PCI outcomes. This study evaluated multivessel PCI patients to determine the predictors of complete revascularization and the association of complete revascularization with survival, subsequent CABG, and repeat PCI.
Methods: The Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH) is a clinical data collection and outcome-monitoring initiative capturing all patients undergoing cardiac catheterization and revascularization in the province of Alberta, Canada. Characteristics and long-term outcomes of 1308 patients undergoing multivessel PCI with complete revascularization were compared with those of 648 patients with incomplete revascularization.
Results: The significant independent predictors of complete revascularization were pre-PCI Duke jeopardy score, the presence of a total occlusion, year of PCI, age N 65 years, renal failure, and left ventricular function. With a median follow-up time of 3.0 F 1.8 years, the adjusted hazard ratio (HR) (95% CI) for the association between complete revascularization and outcome was 0.75 (0.54-1.04) for death, 0.55 (0.37-0.84) for subsequent CABG, and 0.93 (0.65-1.34) for repeat PCI.
Conclusions: Baseline angiographic characteristics and other clinical factors can predict complete revascularization in patients undergoing multivessel PCI. Complete multivessel PCI is associated with reduced need for future CABG, a trend toward better survival, and no difference in repeat PCI.