Incomplete Revascularization in the Era of Drug-Eluting Stents. Impact on Adverse Outcomes

Objectives: We sought to compare outcomes for percutaneous coronary intervention patients undergoing complete revascularization (CR) and incomplete revascularization (IR) in the drug-eluting stent era. Background: There have been relatively few studies that have examined the impact of IR in patients undergoing coronary stenting, particularly in the era of drug-eluting stents. Methods: New York State's Percutaneous Coronary Intervention Reporting System was used to identify 11,294 stent patients with multivessel disease undergoing either IR or CR in 39 hospitals between October 1, 2003, and December 31, 2004. These patients were followed through December 31, 2005, and IR patients were subdivided based on the number of IR vessels and presence of a chronic total occlusion. Risk-adjusted mortality and mortality/myocardial infarction (MI) for CR and IR patients were compared at 18 months. Results: Incomplete revascularization was performed in a total of 7,795 patients (69.0%). Incomplete revascularization was associated with higher 18-month mortality (adjusted hazard ratio [HR]: 1.23, 95% confidence interval [CI]: 1.04 to 1.45) and higher 18-month MI/mortality (adjusted HR: 1.27, 95% CI: 1.09 to 1.47). The risk-adjusted survival rates for CR and IR were 94.9% and 93.8% (p = 0.01). The risk-adjusted survival/freedom from MI rates were 93.3% and 91.7% (p = 0.002). Patients with 2 diseased vessels unattempted with a total occlusion were at highest risk (adjusted survival HR: 1.44, 95% CI: 1.14 to 1.82, risk-adjusted survival 94.9% vs. 92.9%, p = 0.002; and adjusted survival/freedom from MI: 1.50, 95% CI: 1.21 to 1.86, rates 93.3% vs. 90.3%, p < 0.001). Conclusions: Patients undergoing coronary stenting who receive IR experience more adverse outcomes even in the era of drug-eluting stents. This has implications for choice of procedure and post-procedural monitoring.