J Korean Med Sci.  2014 Nov;29(11):1501-1506. 10.3346/jkms.2014.29.11.1501.

Long-Term Outcomes of Complete Versus Incomplete Revascularization for Patients with Multivessel Coronary Artery Disease and Left Ventricular Systolic Dysfunction in Drug-Eluting Stent Era

Affiliations
  • 1Division of Cardiology, Department of Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.
  • 2Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. sh1214.choi@samsung.com
  • 3Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
  • 4Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Abstract

We aimed to investigate that complete revascularization (CR) would be associated with a decreased mortality in patients with multivessel disease (MVD) and reduced left ventricular ejection fraction (LVEF). We enrolled a total of 263 patients with MVD and LVEF <50% who had undergone percutaneous coronary intervention with drug-eluting stent between March 2003 and December 2010. We compared major adverse cardiac and cerebrovascular accident (MACCE) including all-cause death, myocardial infarction, any revascularization, and cerebrovascular accident between CR and incomplete revascularization (IR). CR was achieved in 150 patients. During median follow-up of 40 months, MACCE occurred in 52 (34.7%) patients in the CR group versus 51 (45.1%) patients in the IR group (P=0.06). After a Cox regression model with inverse-probability-of-treatment-weighting using propensity score, the incidence of MACCE of the CR group were lower than those of the IR group (34.7% vs. 45.1%; adjusted hazard ratio [HR], 0.65; 95% confidence interval [CI], 0.44-0.95, P=0.03). The rate of all-cause death was significantly lower in patients with CR than in those with IR (adjusted HR, 0.48; 95% CI, 0.29-0.80, P<0.01). In conclusion, the achievement of CR with drug-eluting stent reduces long-term MACCE in patients with MVD and reduced LVEF.

Keyword

Drug-Eluting Stents; Left Ventricular Systolic Dysfunction; Revascularization

MeSH Terms

Age Factors
Aged
Coronary Artery Disease/*drug therapy/mortality/physiopathology
Diabetes Mellitus, Type 2/complications
*Drug-Eluting Stents
Female
Follow-Up Studies
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Myocardial Infarction/etiology
Myocardial Revascularization
Percutaneous Coronary Intervention/adverse effects
Proportional Hazards Models
Renal Insufficiency, Chronic/complications
Retrospective Studies
Sex Factors
Treatment Outcome
Ventricular Dysfunction, Left/physiopathology

Figure

  • Fig. 1 Kaplan-Meier curves for outcome in patients with complete versus incomplete revascularization. Kaplan-Meier curves for (A) MACCE, and (B) cardiac death in patients with CR (solid line) versus IR (dashed line). CR, complete revascularization; IR, incomplete revascularization; MACCE, major adverse cardiac and cerebrovascular event; PCI, percutaneous coronary intervention.

  • Fig. 2 Comparative unadjusted HRs of treatment strategy for MACCE. CR, complete revascularization; IR, incomplete revascularization; LVEF, left ventricular ejection fraction; MACCE, major adverse cardiac and cerebrovascular event.


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