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Impact of incomplete percutaneous revascularization in patients with multivessel coronary artery disease: a systematic review and meta-analysis

Impact of incomplete percutaneous revascularization in patients with multivessel coronary artery disease: a systematic review and meta-analysis
Impact of incomplete percutaneous revascularization in patients with multivessel coronary artery disease: a systematic review and meta-analysis

BACKGROUND: Up to half of patients undergoing percutaneous coronary intervention have multivessel coronary artery disease (MVD) with conflicting data regarding optimal revascularization strategy in such patients. This paper assesses the evidence for complete revascularization (CR) versus incomplete revascularization in patients undergoing percutaneous coronary intervention, and its prognostic impact using meta-analysis.

METHODS AND RESULTS: A search of PubMed, EMBASE, MEDLINE, Current Contents Connect, Google Scholar, Cochrane library, Science Direct, and Web of Science was conducted to identify the association of CR in patients with multivessel coronary artery disease undergoing percutaneous coronary intervention with major adverse cardiac events and mortality. Random-effects meta-analysis was used to estimate the odds of adverse outcomes. Meta-regression analysis was conducted to assess the relationship with continuous variables and outcomes. Thirty-eight publications that included 156 240 patients were identified. Odds of death (OR 0.69, 95% CI 0.61-0.78), repeat revascularization (OR 0.60, 95% CI 0.45-0.80), myocardial infarction (OR 0.64, 95% CI 0.50-0.81), and major adverse cardiac events (OR 0.63, 95% CI 0.50-0.79) were significantly lower in the patients who underwent CR. These outcomes were unchanged on subgroup analysis regardless of the definition of CR. Similar findings were recorded when CR was studied in the chronic total occlusion (CTO) subgroup (OR 0.65, 95% CI 0.53-0.80). A meta-regression analysis revealed a negative relationship between the OR for mortality and the percentage of CR.

CONCLUSION: CR is associated with reduced risk of mortality and major adverse cardiac events, irrespective of whether an anatomical or a score-based definition of incomplete revascularization is used, and this magnitude of risk relates to degree of CR. These results have important implications for the interventional management of patients with multivessel coronary artery disease.

Aged, Coronary Artery Disease/mortality, Coronary Occlusion/surgery, Female, Graft Occlusion, Vascular/etiology, Humans, Male, Middle Aged, Myocardial Revascularization/methods, Percutaneous Coronary Intervention/methods, Publication Bias, Randomized Controlled Trials as Topic, Regression Analysis, Reoperation, Risk Factors, Stents
1-22
Nagaraja, Vinayak
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Ooi, Sze-Yuan
9ae8b5c0-f7f7-4088-8984-30a8b3cc3229
Nolan, James
1cdb1e12-958f-4b04-a730-242dd48591b1
Large, Adrian
a076b2e3-62d0-418f-9494-21eea7b82756
De Belder, Mark
f0106dad-a7dd-4c54-a47e-03ec4c5c826f
Ludman, Peter
28ef305d-e09e-40a7-84b4-6ccedfb37cc8
Bagur, Rodrigo
4afad05d-aab4-48c7-ab89-fa9802123c59
Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4
Matsukage, Takashi
8e63aad8-e870-42df-98ec-2c7d97787619
Yoshimachi, Fuminobu
98bf2e36-8aa4-40ec-94e7-48adfae4c6b5
Kwok, Chun Shing
000170fb-8506-4c19-9481-e56d93049fef
Berry, Colin
106fbcaa-69ba-45ec-969f-6f18e06680cf
Mamas, Mamas A
b71e6a0a-07a4-4822-a10e-c02a6b29ae5d
Nagaraja, Vinayak
fe8a6557-9710-489a-9658-0a1f8818b9c8
Ooi, Sze-Yuan
9ae8b5c0-f7f7-4088-8984-30a8b3cc3229
Nolan, James
1cdb1e12-958f-4b04-a730-242dd48591b1
Large, Adrian
a076b2e3-62d0-418f-9494-21eea7b82756
De Belder, Mark
f0106dad-a7dd-4c54-a47e-03ec4c5c826f
Ludman, Peter
28ef305d-e09e-40a7-84b4-6ccedfb37cc8
Bagur, Rodrigo
4afad05d-aab4-48c7-ab89-fa9802123c59
Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4
Matsukage, Takashi
8e63aad8-e870-42df-98ec-2c7d97787619
Yoshimachi, Fuminobu
98bf2e36-8aa4-40ec-94e7-48adfae4c6b5
Kwok, Chun Shing
000170fb-8506-4c19-9481-e56d93049fef
Berry, Colin
106fbcaa-69ba-45ec-969f-6f18e06680cf
Mamas, Mamas A
b71e6a0a-07a4-4822-a10e-c02a6b29ae5d

Nagaraja, Vinayak, Ooi, Sze-Yuan, Nolan, James, Large, Adrian, De Belder, Mark, Ludman, Peter, Bagur, Rodrigo, Curzen, Nick, Matsukage, Takashi, Yoshimachi, Fuminobu, Kwok, Chun Shing, Berry, Colin and Mamas, Mamas A (2016) Impact of incomplete percutaneous revascularization in patients with multivessel coronary artery disease: a systematic review and meta-analysis. Journal of the American Heart Association, 5 (12), 1-22. (doi:10.1161/JAHA.116.004598).

Record type: Review

Abstract

BACKGROUND: Up to half of patients undergoing percutaneous coronary intervention have multivessel coronary artery disease (MVD) with conflicting data regarding optimal revascularization strategy in such patients. This paper assesses the evidence for complete revascularization (CR) versus incomplete revascularization in patients undergoing percutaneous coronary intervention, and its prognostic impact using meta-analysis.

METHODS AND RESULTS: A search of PubMed, EMBASE, MEDLINE, Current Contents Connect, Google Scholar, Cochrane library, Science Direct, and Web of Science was conducted to identify the association of CR in patients with multivessel coronary artery disease undergoing percutaneous coronary intervention with major adverse cardiac events and mortality. Random-effects meta-analysis was used to estimate the odds of adverse outcomes. Meta-regression analysis was conducted to assess the relationship with continuous variables and outcomes. Thirty-eight publications that included 156 240 patients were identified. Odds of death (OR 0.69, 95% CI 0.61-0.78), repeat revascularization (OR 0.60, 95% CI 0.45-0.80), myocardial infarction (OR 0.64, 95% CI 0.50-0.81), and major adverse cardiac events (OR 0.63, 95% CI 0.50-0.79) were significantly lower in the patients who underwent CR. These outcomes were unchanged on subgroup analysis regardless of the definition of CR. Similar findings were recorded when CR was studied in the chronic total occlusion (CTO) subgroup (OR 0.65, 95% CI 0.53-0.80). A meta-regression analysis revealed a negative relationship between the OR for mortality and the percentage of CR.

CONCLUSION: CR is associated with reduced risk of mortality and major adverse cardiac events, irrespective of whether an anatomical or a score-based definition of incomplete revascularization is used, and this magnitude of risk relates to degree of CR. These results have important implications for the interventional management of patients with multivessel coronary artery disease.

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More information

Accepted/In Press date: 28 October 2016
Published date: 16 December 2016
Keywords: Aged, Coronary Artery Disease/mortality, Coronary Occlusion/surgery, Female, Graft Occlusion, Vascular/etiology, Humans, Male, Middle Aged, Myocardial Revascularization/methods, Percutaneous Coronary Intervention/methods, Publication Bias, Randomized Controlled Trials as Topic, Regression Analysis, Reoperation, Risk Factors, Stents

Identifiers

Local EPrints ID: 436091
URI: http://eprints.soton.ac.uk/id/eprint/436091
PURE UUID: 4e15062d-76f4-4cab-93e7-1f4f3a97ecb9
ORCID for Nick Curzen: ORCID iD orcid.org/0000-0001-9651-7829

Catalogue record

Date deposited: 27 Nov 2019 17:30
Last modified: 28 Apr 2022 01:55

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Contributors

Author: Vinayak Nagaraja
Author: Sze-Yuan Ooi
Author: James Nolan
Author: Adrian Large
Author: Mark De Belder
Author: Peter Ludman
Author: Rodrigo Bagur
Author: Nick Curzen ORCID iD
Author: Takashi Matsukage
Author: Fuminobu Yoshimachi
Author: Chun Shing Kwok
Author: Colin Berry
Author: Mamas A Mamas

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