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Complete revascularization optimizes patient outcomes in multivessel coronary artery disease: Data from the e‐Ultimaster registry

OBJECTIVES: The aim of this analysis was to assess the effect of the coronary revascularization strategy during index admission on clinical outcomes among patients undergoing percutaneous coronary intervention (PCI) with multivessel coronary artery disease (MVD). BACKGROUND: The value of complete re...

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Autores principales: Williams, Timothy, Mittal, Aaina, Karageorgiev, Dimitar, Iniguez Romo, Andres, Aminian, Adel, Fernandez Portalese, Javier, Kharrat, Elyes, Gómez‐Hospital, Joan Antoni, Firman, Doni, Trillo Nouche, Ramiro, Hildick‐Smith, David
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9544253/
https://www.ncbi.nlm.nih.gov/pubmed/34962059
http://dx.doi.org/10.1002/ccd.30042
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author Williams, Timothy
Mittal, Aaina
Karageorgiev, Dimitar
Iniguez Romo, Andres
Aminian, Adel
Fernandez Portalese, Javier
Kharrat, Elyes
Gómez‐Hospital, Joan Antoni
Firman, Doni
Trillo Nouche, Ramiro
Hildick‐Smith, David
author_facet Williams, Timothy
Mittal, Aaina
Karageorgiev, Dimitar
Iniguez Romo, Andres
Aminian, Adel
Fernandez Portalese, Javier
Kharrat, Elyes
Gómez‐Hospital, Joan Antoni
Firman, Doni
Trillo Nouche, Ramiro
Hildick‐Smith, David
author_sort Williams, Timothy
collection PubMed
description OBJECTIVES: The aim of this analysis was to assess the effect of the coronary revascularization strategy during index admission on clinical outcomes among patients undergoing percutaneous coronary intervention (PCI) with multivessel coronary artery disease (MVD). BACKGROUND: The value of complete revascularization (CR) over incomplete revascularization (IR) in MVD patients is not fully established. METHODS: Patients with MVD defined as ≥2 major epicardial vessels with ≥50% stenosis were selected from the observational all‐comer e‐Ultimaster registry. Patients were treated with a sirolimus‐eluting thin‐strut coronary stent. Completeness of revascularization was physician assessed at the index procedure or an eventually staged procedure during the index hospitalization. Outcomes measures at 1 year were target lesion failure (TLF) (composite of cardiac death, target vessel‐related myocardial infarction [MI], and clinically driven target lesion revascularization [TLR]), and patient‐oriented composite endpoint (POCE) (all‐cause mortality, MI, or revascularization). The inverse probability of treatment weights (IPTW) methodology was used to perform a matched analysis. RESULTS: The registry recruited 37,198 patients of whom 15,441 (41.5%) had MVD. CR on hospital discharge was achieved in 7413 (48.0%) patients and IR in 8028 (52.0%) patients. Mean age was 64.6 ± 11.1 versus 65.7 ± 11.0 years (p < 0.01), male gender 77.9% and 77.3% (p = 0.41) and diabetes 31.3% versus 33.4% (p = 0.01) for CR and IR, respectively. Chronic stable angina patients more commonly underwent CR (47.6% vs. 36.8%, p < 0.01). After propensity weighted analysis, 90.5% of CR patients were angina‐free at 1 year compared with 87.5% of IR patients (p < 0.01). TLF (3.3% vs. 4.4%; p < 0.01), POCE (6.8% vs. 10.8%; p < .01), and all‐cause mortality (2.3% vs. 3.1%; p < .01) were all lower in CR patients. CONCLUSIONS: A physician‐directed use of a CR strategy utilizing sirolimus‐eluting thin‐strut stent results in optimized clinical outcomes and less angina in an all‐comer population. Our findings suggest that a CR should be aimed for.
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spelling pubmed-95442532022-10-14 Complete revascularization optimizes patient outcomes in multivessel coronary artery disease: Data from the e‐Ultimaster registry Williams, Timothy Mittal, Aaina Karageorgiev, Dimitar Iniguez Romo, Andres Aminian, Adel Fernandez Portalese, Javier Kharrat, Elyes Gómez‐Hospital, Joan Antoni Firman, Doni Trillo Nouche, Ramiro Hildick‐Smith, David Catheter Cardiovasc Interv Coronary Artery Disease OBJECTIVES: The aim of this analysis was to assess the effect of the coronary revascularization strategy during index admission on clinical outcomes among patients undergoing percutaneous coronary intervention (PCI) with multivessel coronary artery disease (MVD). BACKGROUND: The value of complete revascularization (CR) over incomplete revascularization (IR) in MVD patients is not fully established. METHODS: Patients with MVD defined as ≥2 major epicardial vessels with ≥50% stenosis were selected from the observational all‐comer e‐Ultimaster registry. Patients were treated with a sirolimus‐eluting thin‐strut coronary stent. Completeness of revascularization was physician assessed at the index procedure or an eventually staged procedure during the index hospitalization. Outcomes measures at 1 year were target lesion failure (TLF) (composite of cardiac death, target vessel‐related myocardial infarction [MI], and clinically driven target lesion revascularization [TLR]), and patient‐oriented composite endpoint (POCE) (all‐cause mortality, MI, or revascularization). The inverse probability of treatment weights (IPTW) methodology was used to perform a matched analysis. RESULTS: The registry recruited 37,198 patients of whom 15,441 (41.5%) had MVD. CR on hospital discharge was achieved in 7413 (48.0%) patients and IR in 8028 (52.0%) patients. Mean age was 64.6 ± 11.1 versus 65.7 ± 11.0 years (p < 0.01), male gender 77.9% and 77.3% (p = 0.41) and diabetes 31.3% versus 33.4% (p = 0.01) for CR and IR, respectively. Chronic stable angina patients more commonly underwent CR (47.6% vs. 36.8%, p < 0.01). After propensity weighted analysis, 90.5% of CR patients were angina‐free at 1 year compared with 87.5% of IR patients (p < 0.01). TLF (3.3% vs. 4.4%; p < 0.01), POCE (6.8% vs. 10.8%; p < .01), and all‐cause mortality (2.3% vs. 3.1%; p < .01) were all lower in CR patients. CONCLUSIONS: A physician‐directed use of a CR strategy utilizing sirolimus‐eluting thin‐strut stent results in optimized clinical outcomes and less angina in an all‐comer population. Our findings suggest that a CR should be aimed for. John Wiley and Sons Inc. 2021-12-28 2022-03-01 /pmc/articles/PMC9544253/ /pubmed/34962059 http://dx.doi.org/10.1002/ccd.30042 Text en © 2021 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC https://creativecommons.org/licenses/by-nc/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Coronary Artery Disease
Williams, Timothy
Mittal, Aaina
Karageorgiev, Dimitar
Iniguez Romo, Andres
Aminian, Adel
Fernandez Portalese, Javier
Kharrat, Elyes
Gómez‐Hospital, Joan Antoni
Firman, Doni
Trillo Nouche, Ramiro
Hildick‐Smith, David
Complete revascularization optimizes patient outcomes in multivessel coronary artery disease: Data from the e‐Ultimaster registry
title Complete revascularization optimizes patient outcomes in multivessel coronary artery disease: Data from the e‐Ultimaster registry
title_full Complete revascularization optimizes patient outcomes in multivessel coronary artery disease: Data from the e‐Ultimaster registry
title_fullStr Complete revascularization optimizes patient outcomes in multivessel coronary artery disease: Data from the e‐Ultimaster registry
title_full_unstemmed Complete revascularization optimizes patient outcomes in multivessel coronary artery disease: Data from the e‐Ultimaster registry
title_short Complete revascularization optimizes patient outcomes in multivessel coronary artery disease: Data from the e‐Ultimaster registry
title_sort complete revascularization optimizes patient outcomes in multivessel coronary artery disease: data from the e‐ultimaster registry
topic Coronary Artery Disease
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9544253/
https://www.ncbi.nlm.nih.gov/pubmed/34962059
http://dx.doi.org/10.1002/ccd.30042
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