Multivessel Disease Patients With Incomplete Revascularization Have Increased Risk of Recurrent Adverse Events

Patients with multivessel disease who undergo percutaneous coronary intervention (PCI) and show signs of incomplete revascularization (IR) at the time of hospital discharge were at increased risk of 1-year recurrent adverse cardiac events, according to data from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR).

Researchers sought to investigate the association IR with death, repeat revascularization, and myocardial infarction (MI) compared to patients with complete revascularization (CR). The study included data from SCAAR, which researchers merged with official Swedish health data registries.

“In this nationwide, observational, registry-based study of all Swedish PCI patients with multivessel disease treated in 2006 to 2010, we observed a high event rate associated with IR after PCI,” the authors wrote in their study, published in JACC: Cardiovascular Interventions.

“Death or MI occurred in 17% of patients with IR and an additional 20% required repeat revascularization. Compared with CR, IR was associated with substantially higher rates after discharge.”

Researchers examined 23 342 patients with multivessel disease from the SCAAR database between 2006 and 2010. This cohort included 15 165 patients with IR and 8177 patients with CR.

The patients with IR were typically older, had more extensive coronary disease, and had ST-segment elevation MI than patients with CR. The all-cause 1-year mortality was 7.1% among patients with IR, which was a higher rate than the patients with CR (3.8%). The MI rate was also higher among the IR group (10.4% vs 6.0%) as well as the rate of repeat revascularization (20.5% vs 8.5%).

The adjusted hazard ratio (HR) for the composite of death, MI, or repeat revascularization at 1 year was higher for IR patients than CR (2.12; 95% confidence interval [CI]: 1.98-2.28; P<.0001). The adjusted HR for death was 1.29 (95% CI: 1.12-1.49; P=.0005) and the ratio for combined death and MI was 1.42 (95% CI: 1.30-1.56; P<.0001).

“Whether this risk can be mitigated by efforts to achieve CR, or by the use of novel adjunctive pharmacological strategies, remains to be further investigated in large randomized trials,” the authors concluded.

Reference

Hambraeus K, Jensevik K, Lagerqvist B. Long-term outcome of incomplete revascularization after percutaneous coronary intervention in SCAAR (Swedish Coronary Angiography and Angioplasty Registry). JACC Cardiovasc Intv. 2016; 9(3):207-215. doi: 10.1016/j.jcin.2015.10.034.