Impact of completeness of percutaneous coronary intervention revascularization on long-term outcomes in the stent era

Edward L. Hannan, Michael Racz, David R. Holmes, Spencer B. King, Gary D Walford, John A. Ambrose, Samin Sharma, Stanley Katz, Luther T. Clark, Robert H. Jones

Research output: Contribution to journalArticle

Abstract

BACKGROUND - The importance of completeness of revascularization by percutaneous coronary intervention in patients with multivessel disease is unclear in that there is little information on the impact of incomplete revascularization outside of randomized trials. The objective of this study is to compare long-term mortality and subsequent revascularization for percutaneous coronary intervention patients receiving stents who were completely revascularized (CR) with those who were incompletely revascularized (IR). METHODS AND RESULTS - Patients from New York State's Percutaneous Coronary Interventions Reporting System were subdivided into patients who were CR and IR. Then subsets of IR patients were contrasted with CR patients. Differences in long-term survival and subsequent revascularization for CR and IR patients were compared after adjustment for differences in preprocedural risk. A total of 68.9% of all stent patients with multivessel disease who were studied were IR, and 30.1% of all patients had total occlusions and/or ≥2 IR vessels. At baseline, the following patients were at higher risk: those who were older and those with more comorbid conditions, worse ejection fraction, and more renal disease and stroke. After adjustment for these baseline differences, IR patients were significantly more likely to die at any time (adjusted hazard ratio=1.15; 95% confidence interval, 1.01 to 1.30) than CR patients. IR patients with total occlusions and a total of ≥2 IR vessels were at the highest risk compared with CR patients (hazard ratio=1.36; 95% confidence interval, 1.12 to 1.66). CONCLUSIONS - IR with stenting is associated with an adverse impact on long-term mortality, and consideration should be given to either achieving CR, opting for surgery, or monitoring percutaneous coronary intervention patients with IR more closely after discharge.

Original languageEnglish (US)
Pages (from-to)2406-2412
Number of pages7
JournalCirculation
Volume113
Issue number20
DOIs
StatePublished - May 2006
Externally publishedYes

Fingerprint

Percutaneous Coronary Intervention
Stents
Confidence Intervals
Mortality

Keywords

  • Angioplasty
  • Mortality
  • Percutaneous coronary intervention
  • Revascularization
  • Stents

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Impact of completeness of percutaneous coronary intervention revascularization on long-term outcomes in the stent era. / Hannan, Edward L.; Racz, Michael; Holmes, David R.; King, Spencer B.; Walford, Gary D; Ambrose, John A.; Sharma, Samin; Katz, Stanley; Clark, Luther T.; Jones, Robert H.

In: Circulation, Vol. 113, No. 20, 05.2006, p. 2406-2412.

Research output: Contribution to journalArticle

Hannan, EL, Racz, M, Holmes, DR, King, SB, Walford, GD, Ambrose, JA, Sharma, S, Katz, S, Clark, LT & Jones, RH 2006, 'Impact of completeness of percutaneous coronary intervention revascularization on long-term outcomes in the stent era', Circulation, vol. 113, no. 20, pp. 2406-2412. https://doi.org/10.1161/CIRCULATIONAHA.106.612267
Hannan, Edward L. ; Racz, Michael ; Holmes, David R. ; King, Spencer B. ; Walford, Gary D ; Ambrose, John A. ; Sharma, Samin ; Katz, Stanley ; Clark, Luther T. ; Jones, Robert H. / Impact of completeness of percutaneous coronary intervention revascularization on long-term outcomes in the stent era. In: Circulation. 2006 ; Vol. 113, No. 20. pp. 2406-2412.
@article{7f87859776bb4ad9b74e595e1523d87c,
title = "Impact of completeness of percutaneous coronary intervention revascularization on long-term outcomes in the stent era",
abstract = "BACKGROUND - The importance of completeness of revascularization by percutaneous coronary intervention in patients with multivessel disease is unclear in that there is little information on the impact of incomplete revascularization outside of randomized trials. The objective of this study is to compare long-term mortality and subsequent revascularization for percutaneous coronary intervention patients receiving stents who were completely revascularized (CR) with those who were incompletely revascularized (IR). METHODS AND RESULTS - Patients from New York State's Percutaneous Coronary Interventions Reporting System were subdivided into patients who were CR and IR. Then subsets of IR patients were contrasted with CR patients. Differences in long-term survival and subsequent revascularization for CR and IR patients were compared after adjustment for differences in preprocedural risk. A total of 68.9{\%} of all stent patients with multivessel disease who were studied were IR, and 30.1{\%} of all patients had total occlusions and/or ≥2 IR vessels. At baseline, the following patients were at higher risk: those who were older and those with more comorbid conditions, worse ejection fraction, and more renal disease and stroke. After adjustment for these baseline differences, IR patients were significantly more likely to die at any time (adjusted hazard ratio=1.15; 95{\%} confidence interval, 1.01 to 1.30) than CR patients. IR patients with total occlusions and a total of ≥2 IR vessels were at the highest risk compared with CR patients (hazard ratio=1.36; 95{\%} confidence interval, 1.12 to 1.66). CONCLUSIONS - IR with stenting is associated with an adverse impact on long-term mortality, and consideration should be given to either achieving CR, opting for surgery, or monitoring percutaneous coronary intervention patients with IR more closely after discharge.",
keywords = "Angioplasty, Mortality, Percutaneous coronary intervention, Revascularization, Stents",
author = "Hannan, {Edward L.} and Michael Racz and Holmes, {David R.} and King, {Spencer B.} and Walford, {Gary D} and Ambrose, {John A.} and Samin Sharma and Stanley Katz and Clark, {Luther T.} and Jones, {Robert H.}",
year = "2006",
month = "5",
doi = "10.1161/CIRCULATIONAHA.106.612267",
language = "English (US)",
volume = "113",
pages = "2406--2412",
journal = "Circulation",
issn = "0009-7322",
publisher = "Lippincott Williams and Wilkins",
number = "20",

}

TY - JOUR

T1 - Impact of completeness of percutaneous coronary intervention revascularization on long-term outcomes in the stent era

AU - Hannan, Edward L.

AU - Racz, Michael

AU - Holmes, David R.

AU - King, Spencer B.

AU - Walford, Gary D

AU - Ambrose, John A.

AU - Sharma, Samin

AU - Katz, Stanley

AU - Clark, Luther T.

AU - Jones, Robert H.

PY - 2006/5

Y1 - 2006/5

N2 - BACKGROUND - The importance of completeness of revascularization by percutaneous coronary intervention in patients with multivessel disease is unclear in that there is little information on the impact of incomplete revascularization outside of randomized trials. The objective of this study is to compare long-term mortality and subsequent revascularization for percutaneous coronary intervention patients receiving stents who were completely revascularized (CR) with those who were incompletely revascularized (IR). METHODS AND RESULTS - Patients from New York State's Percutaneous Coronary Interventions Reporting System were subdivided into patients who were CR and IR. Then subsets of IR patients were contrasted with CR patients. Differences in long-term survival and subsequent revascularization for CR and IR patients were compared after adjustment for differences in preprocedural risk. A total of 68.9% of all stent patients with multivessel disease who were studied were IR, and 30.1% of all patients had total occlusions and/or ≥2 IR vessels. At baseline, the following patients were at higher risk: those who were older and those with more comorbid conditions, worse ejection fraction, and more renal disease and stroke. After adjustment for these baseline differences, IR patients were significantly more likely to die at any time (adjusted hazard ratio=1.15; 95% confidence interval, 1.01 to 1.30) than CR patients. IR patients with total occlusions and a total of ≥2 IR vessels were at the highest risk compared with CR patients (hazard ratio=1.36; 95% confidence interval, 1.12 to 1.66). CONCLUSIONS - IR with stenting is associated with an adverse impact on long-term mortality, and consideration should be given to either achieving CR, opting for surgery, or monitoring percutaneous coronary intervention patients with IR more closely after discharge.

AB - BACKGROUND - The importance of completeness of revascularization by percutaneous coronary intervention in patients with multivessel disease is unclear in that there is little information on the impact of incomplete revascularization outside of randomized trials. The objective of this study is to compare long-term mortality and subsequent revascularization for percutaneous coronary intervention patients receiving stents who were completely revascularized (CR) with those who were incompletely revascularized (IR). METHODS AND RESULTS - Patients from New York State's Percutaneous Coronary Interventions Reporting System were subdivided into patients who were CR and IR. Then subsets of IR patients were contrasted with CR patients. Differences in long-term survival and subsequent revascularization for CR and IR patients were compared after adjustment for differences in preprocedural risk. A total of 68.9% of all stent patients with multivessel disease who were studied were IR, and 30.1% of all patients had total occlusions and/or ≥2 IR vessels. At baseline, the following patients were at higher risk: those who were older and those with more comorbid conditions, worse ejection fraction, and more renal disease and stroke. After adjustment for these baseline differences, IR patients were significantly more likely to die at any time (adjusted hazard ratio=1.15; 95% confidence interval, 1.01 to 1.30) than CR patients. IR patients with total occlusions and a total of ≥2 IR vessels were at the highest risk compared with CR patients (hazard ratio=1.36; 95% confidence interval, 1.12 to 1.66). CONCLUSIONS - IR with stenting is associated with an adverse impact on long-term mortality, and consideration should be given to either achieving CR, opting for surgery, or monitoring percutaneous coronary intervention patients with IR more closely after discharge.

KW - Angioplasty

KW - Mortality

KW - Percutaneous coronary intervention

KW - Revascularization

KW - Stents

UR - http://www.scopus.com/inward/record.url?scp=33744468517&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33744468517&partnerID=8YFLogxK

U2 - 10.1161/CIRCULATIONAHA.106.612267

DO - 10.1161/CIRCULATIONAHA.106.612267

M3 - Article

C2 - 16702469

AN - SCOPUS:33744468517

VL - 113

SP - 2406

EP - 2412

JO - Circulation

JF - Circulation

SN - 0009-7322

IS - 20

ER -