Incomplete Revascularization is Associated with Higher Risk of Long-Term Mortality after Stenting in the Era of First Generation Drug-Eluting Stents

摘要

The association between incomplete revascularization (IR) and long-term mortality following stenting in the era of drug-eluting stents (DES) is not well understood. In this study, we test the hypothesis that IR is associated with a higher risk of long-term (5-year) mortality following stenting for multivessel coronary disease. Using data from New York State’s Percutaneous Coronary Intervention Reporting System, 21,767 patients with multivessel disease who underwent stenting between October 2003 and December 2005 were identified. Complete revascularization (CR) was achieved in 6,844 (31.4%) patients, and 14,923 (68.6%) patients were incompletely revascularized. The CR and IR patients were propensity-matched on a 1:1 ratio on the number of diseased vessels, the presence of total occlusion, type of stents, and the probability of achieving CR estimated using a logistic model with established risk factors as independent variables. Patients were followed for vital status until December 31, 2008 using the National Death Index. Differences in survival between the matched CR and IR patients were compared. Among the 6,511 pairs of propensity-matched patients, the 5-year survival rate for IR was lower compared to CR (79.3% vs. 81.4%, P=0.004), and the risk of death during follow-up was 16% higher for IR in comparison to CR (hazard ratio=1.16, 95% confidence interval: 1.06–1.27, P=0.001). In addition, subgroup analyses demonstrated that the association between IR and long-term mortality was not dependent on major patient risk factors. In conclusion, IR is associated with an increased risk of long-term mortality following stenting for multivessel disease in the DES era.