Functionally driven complete vs incomplete revascularisation in multivessel coronary artery disease--long-term results from a large cohort.

Background: Complete revascularisation (CR) by means of percutaneous coronary intervention (PCI) has been associated with better long-term prognosis than incomplete revascularisation (IR) in several clinical trials. However, in the published studies, the completeness of myocardial revascularisation has been judged mainly on an anatomical basis, while including criteria directed at functionally driven IR might lead to different results.

Aim: To examine the potential value of functionally driven IR in a large cohort of patients with multivessel coronary artery disease (MVD) undergoing PCI.

Methods: The study population consisted of 908 patients with MVD undergoing PCI without stenting between 1988 and 1997. Functionally driven IR was defined as dilation of all segments with >70% stenosis, with the exception of arteries supplying an area of previous transmural myocardial infarction (MI) or a small amount of myocardium. Complete revascularisation was defined as successful PCI of all coronary artery lesions with significant narrowing not fulfilling the above criteria. Patients were followed for a mean 11 years (range 8-16 years). End-points included: death, MI, re-PCI or coronary artery bypass grafting (CABG).

Results: Complete revascularisation was performed in 284 (31.3%) patients. Follow-up was obtained from 873 (96.1%) patients. There was no significant difference in the frequency of all-cause mortality, cardiovascular deaths or MI between patients who underwent CR and IR. Patients who underwent IR were more likely to require re-PCI and had a trend toward more frequent CABG.

Conclusions: In comparison to CR, a strategy of functionally driven IR by means of PCI without stenting does not increase the rate of major cardiovascular outcomes, but is related to higher frequency of repeat procedures during a long-term follow-up.