Outcomes after complete versus incomplete revascularization of patients with multivessel coronary artery disease: A meta-analysis of 89,883 patients enrolled in randomized clinical trials and observational studies

Santiago Garcia, Yader Sandoval, Henri Roukoz, Selcuk Adabag, Mariana Canoniero, Demetris Yannopoulos, Emmanouil S. Brilakis

Research output: Contribution to journalArticle

206 Scopus citations

Abstract

Objectives This study sought to perform a systematic review and meta-analysis of studies comparing complete revascularization (CR) versus incomplete revascularization (IR) in patients with multivessel coronary artery disease. Background There are conflicting data regarding the benefits of CR in patients with multivessel coronary artery disease. Methods We identified observational studies and subgroup analysis of randomized clinical trials (RCT) published in PubMed from 1970 through September 2012 using the following keywords: "percutaneous coronary intervention" (PCI); "coronary artery bypass graft" (CABG); "complete revascularization"; and "incomplete revascularization." Main outcome measures were total mortality, myocardial infarction, and repeat revascularization procedures. Results We identified 35 studies including 89,883 patients, of whom 45,417 (50.5%) received CR and 44,466 (49.5%) received IR. IR was more common after PCI than after CABG (56% vs. 25%; p < 0.001). Relative to IR, CR was associated with lower long-term mortality (risk ratio [RR]: 0.71, 95% confidence interval [CI]: 0.65 to 0.77; p < 0.001), myocardial infarction (RR: 0.78, 95% CI: 0.68 to 0.90; p = 0.001), and repeat coronary revascularization (RR: 0.74, 95% CI: 0.65 to 0.83; p < 0.001). The mortality benefit associated with CR was consistent across studies irrespective of revascularization modality (CABG: RR: 0.70, 95% CI: 0.61 to 0.80; p < 0.001; and PCI: RR: 0.72, 95% CI: 0.64 to 0.81; p < 0.001) and definition of CR (anatomic definition: RR: 0.73, 95% CI: 0.67 to 0.79; p < 0.001; and nonanatomic definition: RR: 0.57, 95% CI: 0.36 to 0.89; p = 0.014). Conclusions CR is achieved more commonly with CABG than with PCI. Among patients with multivessel coronary artery disease, CR may be the optimal revascularization strategy.

Original languageEnglish (US)
Pages (from-to)1421-1431
Number of pages11
JournalJournal of the American College of Cardiology
Volume62
Issue number16
DOIs
StatePublished - Oct 15 2013

Keywords

  • complete revascularization coronary artery bypass surgery coronary artery disease meta-analysis percutaneous coronary intervention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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