Incomplete revascularization with BMS linked to increased mortality
MedWire News: Incomplete revascularization (IR) may be associated with an increased risk for long-term mortality in multivessel disease patients who are implanted with bare metal stents (BMS), a study suggests.
This finding should be considered when determining how percutaneous coronary intervention (PCI) is performed and when selecting the most appropriate method of revascularization, remark Chuntao Wu (Penn State Hershey College of Medicine, Philadelphia, USA) and co-authors in the journal Circulation: Cardiovascular Interventions.
The team studied 13,016 patients with multivessel disease who underwent BMS implantation between 1999 and 2000. The researchers used baseline risk factors (such as cardiopulmonary resuscitation, left ventricular hypertrophy, and congestive heart failure) to fit a logistic regression model that predicted the probability of these patients achieving complete revascularization (CR). The CR patients were matched to IR patients who had a similar chance of undergoing CR.
Wu et al then followed each patient's vital status through 2007 using the National Death Index, and compared the difference in long-term mortality between IR and CR.
They found that CR was achieved in 3803 (29.2%) patients. Among the 3803 pair-matched patients, the 8-year survival rates were 80.8% and 78.5% for the CR and IR patients, respectively (p=0.04).
Further analysis revealed that the risk for death was 12% higher for IR patients than CR patients, a marginally significant association (p=0.04).
The survival disadvantage seen in IR patients was not limited to any subgroups of patients as determined by age, ejection fraction, myocardial infarction history, congestive heart failure, diabetes, left anterior ascending artery disease, proximal vessel disease, or the presence of a total occlusion, the authors note.
"Therefore… the impact of IR on long-term mortality is not highly dependent on the baseline risk factors in the study," they say.
Adjustment for baseline risk factors revealed that IR was indeed associated with a higher risk for mortality than CR (hazard ratio=1.16; p=0.001).
"More prospective studies are needed to further test this association," Wu and team conclude.
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By Piriya Mahendra