Effects Of Complete And Incomplete Revascularization In Severe Coronary Patients With Multi-vessel Disease After Drug-eluting Stent Implantation

Background and ObjectiveWith the acceleration of population aging, more and more people suffering from multi-vessel disease. It seriously affects people's health. Often in patients with multi-vessel coronary artery disease with left main disease, chronic total occlusion, coronary bifurcation lesions, long lesions, ostial lesion and other complex diseases. So in the early intervention, multi-vessel disease is still an absolute indication for CABG. But with the extensive use of DES in clinical, more multi-vessel disease patients accept DES implantation for the treatment choice.Number of large-scale clinical study confirmed the DES treatment effect. The SYNTAX trial is the first large scale randomized, controlled clinical trial comparing PCI using drug-eluting stents (DES) to CABG in patients with left main disease and three-vessel disease. The results show that PCI and CABG both can improve prognosis in patients with complex lesions, and there was no significant difference on the impact of the combined end point. This trial introduces SYNTAX SCORE. It confirmed the clinical decision-making on patients with different score. In clinical practice, some patients had complete revascularization, some patients had incomplete revascularization. The two solutions for the long-term survival and major adverse cardiac and cerebral vascular events have no clinical evidence. We address this issue, investigate the efficacy of these two treatment strategies.MethodsThis retrospective study included 118 consecutive CHD patients with multi-vessel disease that underwent successful DES implantation. According to whether complete revascularization, the patients were divided into two groups—the complete revascularization and the incomplete revascularization. Detailed information regarding the occurrence of adverse events composite of all-cause death, recurrence of angina, nonfatal myocardial infarction, nonfatal stroke and revascularization, was obtained during the routine follow-up at 3 years. And combined with SYNTAX score method evaluate the clinical effects.Results1. Between the two groups, the general baseline characteristics were similar. Groups were comparable. Incomplete revascularization group than in the complete revascularization group has more patients with high scores (68%vs34%, P<0.01), and has more CTO patients (40%vs18%, P<0.01).2. Incomplete revascularization group than in the complete revascularization group has more MACCE (37%vs12%, P<0.01).3. SYNTAX SCORE regardless of the level, the incidence of again angina pectoris (15%vs4%) and revascularization (13%vs4%, P<0.01) in non-complete revascularization group has an increase trend. And this trend is more pronounced in patients with high scores.Conclusions 1. The complete revascularization is much better than that of the incomplete revascularization in CHD patients with three vessel disease after DES implantation.2. More complex coronary artery lesions in patients with high scores. Complete revascularization in patients on the benefits of high score is more significant.3. Comprehensive evaluation of patients with high grades to try to achieve complete revascularization.