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Complete versus culprit vessel percutaneous coronary intervention in multivessel disease: a randomized comparison.
Am Heart J. 2004 Sep; 148(3):467-74.AH

Abstract

BACKGROUND

The purpose of this study was to compare the safety, efficacy, and costs of complete versus "culprit" vessel revascularization in multivessel coronary artery disease treated with percutaneous coronary interventions (PCI).

METHODS

Patients with multivessel disease and an identified culprit vessel were randomly assigned to complete revascularization of vessels > or =50% stenoses (n = 108) versus revascularization limited to the culprit vessel (n = 111). The primary end point, major adverse cardiac events (MACE), were defined as cardiac or noncardiac death, myocardial infarction, need for coronary artery bypass graft surgery, and repeat PCI up to 1 year.

RESULTS

Despite equal MACE at 24 hours (6.3% vs 7.4%), strategy success was higher in the culprit vessel than in the complete revascularization group (93.7% vs 81.5%, P =.007). MACE rates at 1 month (14.4% vs 9.3%), 1 year (32.4% vs 26.9%), and 4.6 +/- 1.2 years (40.4% vs 34.6%) were similar in both groups. Repeat PCI was performed more often in the culprit vessel group (31.2% vs 21.2%, P =.06). A lower consumption of medical material was associated with lower procedural costs in the culprit vessel group (5784 vs 7315 Euros; P <.001). However, between 1 year and the end of follow-up, costs had equalized in both groups.

CONCLUSIONS

Complete versus culprit vessel revascularization in multivessel coronary disease treated with PCI was associated with a lower strategy success rate, similar MACE rates, and initially higher costs. However, over the long term, more repeat PCIs were conducted in patients treated by culprit revascularization only, mostly because of the need to treat lesions initially left untreated. As a consequence, incremental costs had equalized within 1 year. The decision of whether to perform culprit vessel or complete revascularization can be made on an individual basis.

Authors+Show Affiliations

Amsterdam Department of Interventional Cardiology OLVG Hospital, Amsterdam, The Netherlands. a.j.j.ijsselmuiden@olvg.nlNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

15389234

Citation

Ijsselmuiden, Alexander J J., et al. "Complete Versus Culprit Vessel Percutaneous Coronary Intervention in Multivessel Disease: a Randomized Comparison." American Heart Journal, vol. 148, no. 3, 2004, pp. 467-74.
Ijsselmuiden AJ, Ezechiels J, Westendorp IC, et al. Complete versus culprit vessel percutaneous coronary intervention in multivessel disease: a randomized comparison. Am Heart J. 2004;148(3):467-74.
Ijsselmuiden, A. J., Ezechiels, J., Westendorp, I. C., Tijssen, J. G., Kiemeneij, F., Slagboom, T., van der Wieken, R., Tangelder, G., Serruys, P. W., & Laarman, G. (2004). Complete versus culprit vessel percutaneous coronary intervention in multivessel disease: a randomized comparison. American Heart Journal, 148(3), 467-74.
Ijsselmuiden AJ, et al. Complete Versus Culprit Vessel Percutaneous Coronary Intervention in Multivessel Disease: a Randomized Comparison. Am Heart J. 2004;148(3):467-74. PubMed PMID: 15389234.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Complete versus culprit vessel percutaneous coronary intervention in multivessel disease: a randomized comparison. AU - Ijsselmuiden,Alexander J J, AU - Ezechiels,JanPaul, AU - Westendorp,Iris C D, AU - Tijssen,Jan G P, AU - Kiemeneij,Ferdinand, AU - Slagboom,Ton, AU - van der Wieken,Ron, AU - Tangelder,GeertJan, AU - Serruys,Patrick W, AU - Laarman,GertJan, PY - 2004/9/25/pubmed PY - 2004/12/17/medline PY - 2004/9/25/entrez SP - 467 EP - 74 JF - American heart journal JO - Am Heart J VL - 148 IS - 3 N2 - BACKGROUND: The purpose of this study was to compare the safety, efficacy, and costs of complete versus "culprit" vessel revascularization in multivessel coronary artery disease treated with percutaneous coronary interventions (PCI). METHODS: Patients with multivessel disease and an identified culprit vessel were randomly assigned to complete revascularization of vessels > or =50% stenoses (n = 108) versus revascularization limited to the culprit vessel (n = 111). The primary end point, major adverse cardiac events (MACE), were defined as cardiac or noncardiac death, myocardial infarction, need for coronary artery bypass graft surgery, and repeat PCI up to 1 year. RESULTS: Despite equal MACE at 24 hours (6.3% vs 7.4%), strategy success was higher in the culprit vessel than in the complete revascularization group (93.7% vs 81.5%, P =.007). MACE rates at 1 month (14.4% vs 9.3%), 1 year (32.4% vs 26.9%), and 4.6 +/- 1.2 years (40.4% vs 34.6%) were similar in both groups. Repeat PCI was performed more often in the culprit vessel group (31.2% vs 21.2%, P =.06). A lower consumption of medical material was associated with lower procedural costs in the culprit vessel group (5784 vs 7315 Euros; P <.001). However, between 1 year and the end of follow-up, costs had equalized in both groups. CONCLUSIONS: Complete versus culprit vessel revascularization in multivessel coronary disease treated with PCI was associated with a lower strategy success rate, similar MACE rates, and initially higher costs. However, over the long term, more repeat PCIs were conducted in patients treated by culprit revascularization only, mostly because of the need to treat lesions initially left untreated. As a consequence, incremental costs had equalized within 1 year. The decision of whether to perform culprit vessel or complete revascularization can be made on an individual basis. SN - 1097-6744 UR - https://www.unboundmedicine.com/medline/citation/15389234/Complete_versus_culprit_vessel_percutaneous_coronary_intervention_in_multivessel_disease:_a_randomized_comparison_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002870304001528 DB - PRIME DP - Unbound Medicine ER -