Complete myocardial revascularization confers a larger clinical benefit when performed with state‐of‐the‐art techniques in high‐risk patients with multivessel coronary artery disease: A meta‐analysis of randomized and observational studies. Issue 1 (2nd April 2015)

• Record Type: Journal Article
• Authors: Zimarino, Marco; Ricci, Fabrizio; Romanello, Mattia; Di Nicola, Marta; Corazzini, Alessandro; De Caterina, Raffaele
• Is Part Of: Catheterization and cardiovascular interventions. Volume 87:Issue 1(2016)
• Page Start: 3
• Page End: 12
• Publication Date: 2015-04-02
• Subjects: coronary artery disease -- coronary artery bypass graft -- percutaneous coronary intervention; Heart -- Diseases -- Diagnosis -- Periodicals; Cardiac catheterization -- Periodicals; 616.1207572
• DOI: 10.1002/ccd.25923
• Languages: English
• ISSNs: 1522-1946

Abstract

Abstract : Objectives: To test whether a strategy of complete revascularization (CR) as compared with incomplete myocardial revascularization (IR)—both performed with current "state‐of‐the‐art" percutaneous coronary interventions (PCI) or coronary artery bypass graft (CABG)—would provide a clinical benefit in patients with multivessel coronary artery disease (MVCAD). Background: The "optimal" extent of myocardial revascularization remains to be determined.Methods : We performed a meta‐analysis of studies reporting on clinical outcomes of MVCAD patients treated with CR and IR, with extensive (>80%) use of stents for PCI or arterial conduits in CABG. Relative risk (RR) and 95% confidence intervals (CIs) for all‐cause mortality were assessed as primary endpoint, myocardial infarction (MI) and repeat revascularization as secondary endpoints. Results: A total of 28 studies were identified, including 83, 695 patients with 4.7 ± 4.3 years of follow‐up. Compared with IR, CR was associated with reduced mortality (RR: 0.73; 95% CI 0.66–0.81) both after CABG (RR: 0.76; 95% CI 0.63–0.90) and PCI (RR: 0.73; 95% CI 0.64–0.82). The risks of MI (RR: 0.74; 95% CI 0.64–0.85) and repeat revascularization (RR: 0.77; 95% CI 0.66–0.88) were also lower after CR as compared with IR. Metaregression showed a significant RR reduction of MI associated with more recent publication ( P = 0.021) and increasing prevalence of diabetes ( P = 0.033). Conclusions: In MVCAD, as compared with IR, CR confers a clinical benefit that seems larger in cohorts of patients enrolled in more recent studies and with a higher prevalence of diabetes. © 2015 Wiley Periodicals, Inc.