Author + information
- Peter Moore1,
- Navin Chandra2,
- Imad Nadra1,
- Simon Robinson1,
- Eric Fretz3,
- Lilian Ding4,
- Sean Hardiman4,
- Anthony Fung5,
- Eve Aymong6,
- Albert Chan7,
- Steven Hodge8,
- David Wood9,
- Anthony Della Siega1 and
- Bilal Iqbal1
- 1Royal Jubilee Hospital, Victoria, British Columbia, Canada
- 2Royal Jubilee Hospital, Victoria, British Columbia, Canada
- 3Royal Jubilee Hospital, victoria, British Columbia, Canada
- 4Provincial Health Services Authority, Vancouver, British Columbia, Canada
- 5Vancouver General Hospital, Vancouver, British Columbia, Canada
- 6St. Paul's Hospital, Vancouver, British Columbia, Canada
- 7Royal Columbian Hospital, new westminster, British Columbia, Canada
- 8Kelowna General Hospital, Winnipeg, British Columbia, Canada
- 9Centre for Heart Valve Innovation, St. Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada
More than half of patients undergoing PCI have multivessel disease (MVD). MVD is associated with worse clinical outcomes for stable angina, non ST-elevation acute coronary syndrome (NSTEACS) and ST-elevation ACS (STEACS). Complete revascularization (CR) may reduce the incidence of recurrent ischemia and need for repeat procedures, but whether it impacts long-term mortality is unclear.
We analysed mortality in 28,638 patients with MVD (excluding left main disease) treated with PCI between 2008-2014 in British Columbia. We examined the impact of CR vs. incomplete revascularization at index procedure on 3-year mortality for stable disease (n=8,436), NSTEACS (n=13,174) and STEACS (n=7,028).
CR at the index PCI was undertaken in 4,256 patients (14.9%). The 3-year mortality was lower with CR in the total study cohort (7.9% vs. 11.3%, p<0.001); stable cohort (7.9% vs. 12.6%, p<0.001); and NSTEACS cohort (7.9% vs. 12.6%, p<0.001); but not in the STEACS cohort (13.1% vs. 12.7%, p=0.321). CR was an independent predictor for lower mortality in the total, stable and NSTEACS cohorts but comparable mortality in the STEACS cohort. These findings were consistently observed in propensity-matched analyses for total study population (figure1a) and across different indications for PCI (figure1b).
In this large cohort of unselected patients undergoing PCI, CR at the index procedure was an independent predictor of long-term survival. The benefit of CR was specifically seen in patients with stable disease and NSTEACS, with no difference observed in STEACS.
CORONARY: PCI Outcomes