Patients with coronary artery disease not amenable to traditional revascularization: Prevalence and 3-year mortality

Benjamin Williams, Madhav Menon, Daniel Satran, Daniel Hayward, James S Hodges, Nicholas Burke, Randall K. Johnson, Anil K. Poulose, Jay H. Traverse, Timothy D Henry

Research output: Contribution to journalArticlepeer-review

92 Scopus citations

Abstract

Objectives: To determine the contemporary prevalence of and mortality in patients with coronary artery disease (CAD) not amenable to revascularization. Background: A growing number of patients have severe CAD with ongoing angina despite optimal medical therapy which is not amenable to traditional revascularization. Limited data exist on contemporary prevalence and outcome for these patients. Methods: Clinical and angiographic data were reviewed for 493 consecutive patients undergoing coronary angiography and revascularization if indicated. Patients were categorized into six groups: (1) normal coronary arteries, (2) CAD <70%, (3) CAD >70% with complete revascularization by percutaneous intervention or coronary artery bypass grafting, (4) CAD >70% with partial revascularization, (5) CAD >70% treated medically, and (6) CAD >70% on optimal medical therapy with no revascularization option. All-cause mortality at 3 years was determined. Results: Prevalence for groups 1-6 was 14.8, 19.5, 36.9, 12.8, 9.3, and 6.7%, respectively. Three-year mortality increased with angiographic severity of CAD: 2.7, 6.3, 8.2, 12.7, 17.4, and 15.2%, respectively. Patients with incomplete revascularization (groups 4-6, n 5 142) had higher mortality than completely revascularized patients (groups 1-3, n 5 351): 14.8 vs. 6.6% (P 5 0.004). Conclusions: In a contemporary series of patients undergoing coronary angiography, 28.8% (142/493) of patients had significant CAD and did not undergo complete revascularization, including 12.8% partially revascularized, 9.3% managed medically, and 6.7% with "no-option." These patients had higher mortality at 3 years (14.8 vs. 6.6%, P 5 0.004) when compared with completely revascularized patients.

Original languageEnglish (US)
Pages (from-to)886-891
Number of pages6
JournalCatheterization and Cardiovascular Interventions
Volume75
Issue number6
DOIs
StatePublished - May 1 2010

Keywords

  • End-stage coronary artery disease
  • Incomplete revascularization
  • Refractory angina

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