Impact of Angiographic Complete Revascularization After Drug-Eluting Stent Implantation or Coronary Artery Bypass Graft Surgery for Multivessel Coronary Artery Disease
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- Young-Hak Kim
- From the Cardiac Institute (Y.K., D.P., J.L., W.K., J.A., H.G.S., J.O., J.S.P., S.K., S.L., C.W.L., S.-W.P., S.-J.P.) and Division of Biostatistics (S.Y.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
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- Duk-Woo Park
- From the Cardiac Institute (Y.K., D.P., J.L., W.K., J.A., H.G.S., J.O., J.S.P., S.K., S.L., C.W.L., S.-W.P., S.-J.P.) and Division of Biostatistics (S.Y.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
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- Jong-Young Lee
- From the Cardiac Institute (Y.K., D.P., J.L., W.K., J.A., H.G.S., J.O., J.S.P., S.K., S.L., C.W.L., S.-W.P., S.-J.P.) and Division of Biostatistics (S.Y.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
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- Won-Jang Kim
- From the Cardiac Institute (Y.K., D.P., J.L., W.K., J.A., H.G.S., J.O., J.S.P., S.K., S.L., C.W.L., S.-W.P., S.-J.P.) and Division of Biostatistics (S.Y.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
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- Sung-Cheol Yun
- From the Cardiac Institute (Y.K., D.P., J.L., W.K., J.A., H.G.S., J.O., J.S.P., S.K., S.L., C.W.L., S.-W.P., S.-J.P.) and Division of Biostatistics (S.Y.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
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- Jung-Min Ahn
- From the Cardiac Institute (Y.K., D.P., J.L., W.K., J.A., H.G.S., J.O., J.S.P., S.K., S.L., C.W.L., S.-W.P., S.-J.P.) and Division of Biostatistics (S.Y.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
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- Hae Geun Song
- From the Cardiac Institute (Y.K., D.P., J.L., W.K., J.A., H.G.S., J.O., J.S.P., S.K., S.L., C.W.L., S.-W.P., S.-J.P.) and Division of Biostatistics (S.Y.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
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- Jun-Hyok Oh
- From the Cardiac Institute (Y.K., D.P., J.L., W.K., J.A., H.G.S., J.O., J.S.P., S.K., S.L., C.W.L., S.-W.P., S.-J.P.) and Division of Biostatistics (S.Y.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
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- Jong Seon Park
- From the Cardiac Institute (Y.K., D.P., J.L., W.K., J.A., H.G.S., J.O., J.S.P., S.K., S.L., C.W.L., S.-W.P., S.-J.P.) and Division of Biostatistics (S.Y.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
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- Soo-Jin Kang
- From the Cardiac Institute (Y.K., D.P., J.L., W.K., J.A., H.G.S., J.O., J.S.P., S.K., S.L., C.W.L., S.-W.P., S.-J.P.) and Division of Biostatistics (S.Y.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
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- Seung-Whan Lee
- From the Cardiac Institute (Y.K., D.P., J.L., W.K., J.A., H.G.S., J.O., J.S.P., S.K., S.L., C.W.L., S.-W.P., S.-J.P.) and Division of Biostatistics (S.Y.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
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- Cheol Whan Lee
- From the Cardiac Institute (Y.K., D.P., J.L., W.K., J.A., H.G.S., J.O., J.S.P., S.K., S.L., C.W.L., S.-W.P., S.-J.P.) and Division of Biostatistics (S.Y.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
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- Seong-Wook Park
- From the Cardiac Institute (Y.K., D.P., J.L., W.K., J.A., H.G.S., J.O., J.S.P., S.K., S.L., C.W.L., S.-W.P., S.-J.P.) and Division of Biostatistics (S.Y.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
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- Seung-Jung Park
- From the Cardiac Institute (Y.K., D.P., J.L., W.K., J.A., H.G.S., J.O., J.S.P., S.K., S.L., C.W.L., S.-W.P., S.-J.P.) and Division of Biostatistics (S.Y.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
抄録
<jats:sec> <jats:title>Background—</jats:title> <jats:p>This study sought to evaluate the clinical impact of angiographic complete revascularization (CR) after drug-eluting stent implantation or coronary artery bypass graft surgery for multivessel coronary disease.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods and Results—</jats:title> <jats:p> A total of 1914 consecutive patients with multivessel coronary disease undergoing drug-eluting stent implantation (1400 patients) or coronary artery bypass graft surgery (514 patients) were enrolled. Angiographic CR was defined as revascularization in all diseased segments according to the Synergy Between PCI With Taxus and Cardiac Surgery classification. The outcomes of patients undergoing CR were compared with those undergoing incomplete revascularization (IR) after adjustments with the inverse-probability-of-treatment weighting method. Angiographic CR was performed in 917 patients (47.9%) including 573 percutaneous coronary intervention (40.9%) and 344 coronary artery bypass graft (66.9%) patients. CR patients were younger and had more extensive coronary disease than IR patients. Over 5 years, CR patients had comparable incidences of death (8.9% versus 8.9%; adjusted hazard ratio, 1.04; 95% confidence interval, 0.76 to 1.43; <jats:italic>P</jats:italic> =0.81), the composite of death, myocardial infarction, and stroke (12.1% versus 11.9%; adjusted hazard ratio, 1.04; 95% confidence interval, 0.79 to 1.36; <jats:italic>P</jats:italic> =0.80), and the composite of death, myocardial infarction, stroke, and repeat revascularization (22.4% versus 24.9%; adjusted hazard ratio, 0.91; 95% confidence interval, 0.75 to 1.10; <jats:italic>P</jats:italic> =0.32) compared with IR patients. However, 368 patients (19.2%) with multivessel IR had a greater tendency toward higher risk of death, myocardial infarction, stroke, or repeat revascularization (30.3% versus 22.1%; adjusted hazard ratio, 1.27; 95% confidence interval, 0.97 to 1.66; <jats:italic>P</jats:italic> =0.079) than those without multivessel IR. </jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions—</jats:title> <jats:p>Angiographic CR with drug-eluting stent implantation or coronary artery bypass grafting did not improve long-term clinical outcomes in patients with multivessel disease. This finding supports the strategy of ischemia-guided revascularization.</jats:p> </jats:sec>
収録刊行物
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- Circulation
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Circulation 123 (21), 2373-2381, 2011-05-31
Ovid Technologies (Wolters Kluwer Health)