BACKGROUND:Drug-eluting-stents (DES) reduce clinical restenosis, but have mostly failed to demonstrate a reduction in death or myocardial infarction. The aim of this study was to evaluate the prognostic impact of the introduction of DES in patients undergoing multivessel percutaneous coronary intervention (MV-PCI). METHODS:Survival was assessed in 679 consecutive patients, who underwent PCI in at least two main vessels. Follow-up was available in 667 patients (98%) with a mean follow-up of 4.8 ± 2.5 years. We compared several scenarios: firstly, patients receiving at least one DES (≥ 1 DES group) vs. bare metal stent (BMS)-only patients (BMS only); secondly, the population was divided into a pre-DES-era (2000-2003; N=257) and a DES-era (2004-2006; N=422). RESULTS:316 patients (47%) were treated for acute myocardial infarction (MI; N=176 ST-elevation MI; N=140 non-ST-elevation MI). On average, 2.2 ± 0.4 vessels were treated and 212 patients received at least one DES. The DES group showed a higher number of diseased (2.5 ± 0.6 vs. 2.4 ± 0.5; p=0.02) and treated vessels (2.2 ± 0.5 vs. 2.1 ± 0.3; p<0.01) and received more stents (3.3 ± 1.4 vs. 3.0 ± 1.1; p<0.01). The BMS group presented more frequently with acute MI (55% vs. 29%; p<0.01). The DES group showed more complex disease as evidenced by a higher SYNTAX-Score (17.4 ± 8.5 vs. 14.5 ± 8.3; p<0.01). Restricting the survival analysis to patients with stable coronary artery disease, a significant prognostic advantage was found for patients received at least one DES compared to the BMS group (hazard ratio 0.58, 95% confidence interval 0.34-0.99) in the multivariate cox-regression-analysis. CONCLUSION:The introduction of DES leads to extension of treatment to more complex patients. The use of DES is associated with improved survival in stable patients undergoing MV-PCI.

Background: We have previously shown, that clinical risk stratification using the EuroSCORE and completeness of revascularization predicts long-term survival after multivessel PCI (MV-PCI). The SYN...

AIMS/METHODS:Treatment of patients with multivessel coronary artery disease (CAD) has been an ongoing focus of recent clinical studies, questioning the ideal treatment. Randomized trials comparing coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) have so far only included a minority of screened patients. Therefore, we analyzed data from 679 consecutive "all-comer" patients, who underwent PCI in at least two main vessels. Expected in-hospital mortality for CABG was calculated using the EuroSCORE and compared to the observed mortality rate during in-hospital as well as long-term follow-up.RESULTS:The patients were suffering from 2.5 +/- 0.6 diseased vessels, and 2.8 +/- 1.0 lesions were stented (32% of patients received at least one drug-eluting stent [DES]; 20% of lesions were treated with DES). Forty-seven percent of patients were treated for acute coronary syndrome (ACS) (N = 176 ST-elevation myocardial infarction [STEMI]; N = 140 non-ST-elevation myocardial infarction [NSTEMI]). The EuroSCORE was significantly higher in ACS patients compared to stable patients (logistic: STEMI 16.3 +/- 17.2; NSTEMI 13.6 +/- 13.0; stable CAD 3.9 +/- 4.2). The observed in-hospital mortality (STEMI 13.0%; NSTEMI 2.9%; stable CAD 1.7%, P < 0.001) was far lower than the estimated 30-day mortality. Cox regression analysis identified an elevated logistic EuroSCORE (HR per quartile 2.7, P = 0.003), severely reduced left ventricular ejection fraction (HR 2.7, P < 0.001), elevated C-reactive protein (HR 1.8, P = 0.012), and chronic renal failure (HR 2.8, P = 0.001) as independent predictors of long-term mortality.CONCLUSIONS:The EuroSCORE, which is routinely used to estimate the perioperative risk of patients undergoing CABG, also predicts short- and long-term prognosis of patients undergoing MV-PCI. The observed mortality of patients undergoing MV-PCI seems to be much lower than the estimated mortality of CABG.

BACKGROUND:The prognostic relevance of complete revascularization (CR) in patients with multivessel coronary artery disease (MV-CAD) has been established so far for surgical treatment strategies rather than for percutaneous coronary revascularization (PCI). In addition, different definitions of CR have further complicated the interpretation of clinical studies.METHODS:Procedural characteristics and long-term overall survival were assessed in 679 consecutive "all-comer" patients, who underwent PCI in at least two main vessels. We adapted three definitions of CR from the coronary artery bypass grafting (CABG) trials. CR was achieved if following MV-PCI one of the three criteria was met: (1) no residual stenosis in a main coronary vessel, (2) no residual stenosis in any coronary segment, or (3) no residual stenosis in the left anterior descending (LAD) and at least one further main branch. The main objective was the evaluation of predictors of incomplete revascularization and the prognostic impact of CR in MV-PCI patients.RESULTS:CR was achieved in 76%, 67%, and 95%, respectively, (definitions 1-3). Patients without CR were older, had a lower ejection fraction, and presented more often with acute coronary syndromes (ACS). Clinical long-term follow-up regarding survival was available in 664 patients (98%) with a mean follow-up of 2.5 +/- 1.6 years. Independent of the specific definition, CR was associated with a reduced long-term mortality by approximately 50%. After adjusting for relevant baseline parameters, only absence of residual stenosis in all coronary segments remained as an independent predictor of long-term prognosis (hazard ratio [HR]= 0.51, 95% confidence interval [CI]: 0.28-0.93; P = 0.025).CONCLUSIONS:CR of all coronary segments is associated with improved overall survival after MV-PCI.