Study Compares 5-Year Clinical Outcomes of DES for ULMCA Disease Based on Completeness of PCI Revascularization

October 17, 2016—A study that aimed to examine 5-year clinical outcomes of complete, partially complete, and incomplete revascularization in patients with unprotected left main coronary artery (ULMCA) disease treated with drug-eluting stents (DES) was published by Yao-Jun Zhang, PhD, et al in the electronic edition EuroIntervention (2016;12:e957–e963).

According to the investigators, completeness of revascularization—defined as revascularization of all vessels ≥ 1.5 or 2.5 mm in diameter—has been shown to correlate with outcomes after percutaneous coronary intervention (PCI); however, there are no data to compare revascularization strategies on long-term clinical outcomes in patients undergoing PCI of ULMCA disease.

The investigators concluded that in the treatment of patients with ULMCA disease, incomplete revascularization was associated with worse long-term clinical outcomes than complete and partially complete revascularization. Additionally, they found that partially complete revascularization has clinical outcomes similar to complete revascularization in patients with ULMCA disease treated with DES.

As summarized in EuroIntervention, this prospective registry enrolled 910 consecutive patients with ULMCA disease undergoing PCI with DES implantation. The primary endpoint was the incidence of major adverse cardiac events (MACE: a composite of cardiac death, myocardial infarction, and repeat revascularization) at 5-year follow-up. 

Complete revascularization included patients who had a successful revascularization of all diseased segments with diameter ≥ 1.5 mm. Partially complete revascularization included patients who had successful revascularization of all diseased segments with diameter ≥ 2.5 mm. Incomplete revascularization included patients who did not achieve revascularization for all diseased segments of diameter ≥ 2.5 mm. 

Complete revascularization was achieved in 386 (42.4%) patients. Partially complete revascularization was achieved in 227 (25%) patients, and incomplete revascularization was achieved in 297 (32.6%) patients. 

The investigators reported that patients with incomplete revascularization had a significantly higher rate of MACE (29.6% vs 22.5% and 15.5%; P < .001) and all-cause mortality (12.5% vs 7% and 6.2%; P = .006) compared with those patients with complete and partially complete revascularization at 5-year follow-up. 

After propensity score matching, patients with complete versus partially complete revascularization had similar incidences of MACE (hazard ratio [HR], 1.16; 95% confidence interval [CI], 0.78–1.74; P = .46), mortality (HR, 1.27; 95% CI, 0.61–2.63; P = .53), and cardiac death (1.8% vs 4.5%; HR, 2.56; 95% CI, 0.8–8.17; P = .11). On multivariable logistic regression analysis, incomplete revascularization appears to be an outcome of poor clinical characteristics, comorbidities, and complex coronary anatomy, stated the investigators in EuroIntervention.