Complete Revascularization Shown to Improve Outcomes for CAD Patients

April 25, 2010—The Society for Cardiovascular Angiography and Interventions announced that a 3-year, retrospective study conducted at the University of Minnesota's Minneapolis Heart Institute Foundation determined that 28.8% of patients with significant coronary artery disease (CAD) who did not undergo complete revascularization had a higher mortality rate than patients who were completely revascularized. Benjamin Williams, MD, et al published the study in Catheterization and Cardiovascular Interventions (2010;75:886–891).

The investigators reviewed angiographs and clinical data from 493 patients treated at the Minneapolis Heart Institute between July 2005 and August 2005. Patients were categorized based on angiographic results and initial treatment as follows: (1) normal coronaries; (2) CAD < 70%; (3) CAD > 70% with complete revascularization by percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG); (4) CAD > 70% with partial revascularization by PCI or CABG; (5) CAD > 70% without revascularization and treated with medical therapy; and (6) CAD > 70% with no revascularization options despite optimal medical therapy.

The prevalence of treatment options for groups 1 through 6 was 14.8%, 19.5%, 36.9%, 12.8%, 9.3%, and 6.7%, respectively. Three-year mortality rates increased with the angiographic severity of CAD, with groups 1 through 6 having mortality rates of 2.7%, 6.3%, 8.2%, 12.7%, 17.4%, and 15.2%, respectively.

“Our results showed that patients with incomplete revascularization (groups 4–6) had a risk of mortality more than double that of completely revascularized patients,” commented Lead Investigator Timothy D. Henry, MD. After 3 years, patients in the study with partial revascularization had a 14.8% mortality risk compared with 6.6% in patients with complete revascularization.

Additionally, the team found that patients with incomplete revascularization were older, more often male, and more likely to have hypertension, diabetes, peripheral arterial disease, a previous history of CAD including heart attack, PCI, and CABG. Many of the patients in the “no option” group had more than one reason for not undergoing further revascularization including chronic total occlusions (70%), diffuse disease (46%), and collateral dependent perfusion (42%). The “no option” patients had an annual mortality rate of 3% to 5%, which is similar to patients with incomplete revascularization. Researchers speculate the reasons for improved morality could be associated with advances in medical therapy for patients with CAD.

Dr. Henry concluded, “This growing patient population is in need of novel therapeutic strategies aimed at improving not only mortality but also quality of life.”