Meta-Analysis
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Meta-Anal. Dec 26, 2017; 5(6): 167-176
Published online Dec 26, 2017. doi: 10.13105/wjma.v5.i6.167
Complete revascularization reduces adverse outcomes in patients with multivessel coronary artery disease
Merveesh L Auchoybur, Xin Chen
Merveesh L Auchoybur, Xin Chen, Department of Cardiovascular Surgery, Nanjing First Hospital Affiliated to Nanjing Medical University, Nanjing Cardiovascular Disease Research Institute, Nanjing 210006, Jiangsu Province, China
Author contributions: Auchoybur ML acquisition and interpretation of data, study design, drafting the article and final approval; Chen X conception and design of study, critical revision and final approval.
Conflict-of-interest statement: The authors declare that there is no conflict of interest regarding the publication of this paper.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Xin Chen, MD, PhD, Professor, Director, Department of Cardiovascular Surgery, Nanjing First Hospital Affiliated to Nanjing Medical University, Nanjing Cardiovascular Disease Research Institute, 68, Change Road, Nanjing 210006, Jiangsu Province, China. stevecx@njmu.edu.cn
Telephone: +86-25-52271363
Received: July 30, 2017
Peer-review started: August 4, 2017
First decision: September 7, 2017
Revised: September 21, 2017
Accepted: October 29, 2017
Article in press: October 29, 2017
Published online: December 26, 2017
Processing time: 145 Days and 2.8 Hours
Abstract
AIM

To investigate the influence of complete and incomplete revascularization (ICR) in patients with multivessel coronary artery disease undergoing coronary artery bypass or percutaneous coronary intervention.

METHODS

We searched PubMed using the keywords “complete revascularization”, “incomplete revascularization”, “coronary artery bypass”, and “percutaneous coronary intervention”. We selected randomized controlled studies (RCT) and observational studies only for review. The main outcomes of interest were mortality, myocardial infarction (MI) and repeat revascularization. We identified further studies by hand searching relevant publications and included those that met with the inclusion criteria in our final analysis and performed a systematic review.

RESULTS

Ten studies were identified, including 13327 patients of whom, 8053 received complete revascularization and 5274 received ICR. Relative to ICR, CR was associated with lower mortality (RR: 0.755, 95%CI: 0.66 to 0.864, P = 0.765, I2 = 0.0%), lower rates of MI (RR: 0.759, 95%CI: 0.615 to 0.937, P = 0.091, I2 = 45.1%), lower rates of MACCE (RR: 0.731, 95%CI: 0.668 to 0.8, P = 0.453, I2 = 0.0%) and reduced rates of repeat coronary revascularization (RR: 0.691, 95%CI: 0.541 to 0.883, P = 0.0, I2 = 88.3%).

CONCLUSION

CR is associated with lower rates of adverse outcomes. CR can be used as a standard in the choice of any particular revascularization strategy.

Keywords: Complete revascularization; Percutaneous coronary intervention; Coronary artery bypass grafting; Incomplete revascularization

Core tip: Completeness of revascularization has been documented to have lesser adverse post-operative/post-procedural outcomes as compared to incomplete revascularization (ICR). We conduct a systematic review with meta-analysis to analyze the outcomes in patients undergoing CR vs ICR, using any or both techniques. Ten studies were identified, including 13327 patients of whom, 8053 received CR and 5274 received ICR. CR is associated with lower rates of mortality, MI, repeat coronary revascularization procedures, and MACCE. Sub-group analysis also showed reduced rates of adverse events. CR can be used as an aim for any myocardial revascularization procedure.