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
ARTICLE HIGHLIGHTS
Research background

Two strategies are used in the treatment of multivessel coronary artery disease (CAD), namely percutaneous coronary intervention with stenting and coronary artery bypass grafting. Previous studies have proved the importance of complete revascularization. However, the extent to which completeness of revascularization influences the outcomes is still unclear.

Research motivation

Nowadays with new improvements in technology and technique, the feasibility of complete revascularization is less of an issue. Hence, a thorough understanding of how complete revascularization affects post-procedural outcomes is mandatory.

Research objectives

To investigate the influence and outcomes of complete vs incomplete myocardial revascularization in patients with multivessel CAD.

Research methods

Database (pubmed) search coupled with hand search was performed for the identification and collection of relevant studies. Filters, inclusion and exclusion criteria were used to ensure quality and homogenecity of studies. Standard tables were used for data extraction. The data was analyzed and subjected to the appropriate tests by a statistician. A systematic review was then performed.

Research 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, CI: 0.541 to 0.883, P = 0.0, I2 = 88.3%).

Research conclusions

Completeness of revascularization is not mandatory for the treatment of multivessel CAD. The results of our study show that CR is associated with lower rates of adverse outcomes. The results propose that the extent to which a technique can achieve complete revascularization should be a major deciding factor in the choice of any one particular technique.

Research perspectives

Complete revascularization is an alternative standard to decide the choice of a particular technique of revascularization. With emerging techniques of coronary revascularization, new retrospective cohort studies can be performed. Further research is needed to better understand the benefits of complete revascularization with a particular technique.