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Predictors and Outcomes of Staged Versus One-Time Multivessel Revascularization in Multivessel Coronary Artery Disease: Insights From the VA CART Program.

Publication ,  Journal Article
Hu, PT; Jones, WS; Glorioso, TJ; Barón, AE; Grunwald, GK; Waldo, SW; Maddox, TM; Vidovich, M; Banerjee, S; Rao, SV
Published in: JACC Cardiovasc Interv
November 26, 2018

OBJECTIVES: The aim of this study was to determine predictors and outcomes associated with staged percutaneous coronary intervention (PCI) versus one-time multivessel revascularization (OTMVR) in patients with multivessel coronary artery disease. BACKGROUND: Prior observational studies have not evaluated predictors and outcomes of staged PCI versus OTMVR in a heterogenous population of patients with multivessel coronary artery disease who undergo multivessel revascularization. METHODS: Data from the Veterans Affairs (VA) CART (Clinical Assessment, Reporting, and Tracking) Program were used to evaluate patients who underwent PCI of >2 vessels between October 1, 2007, and September 3, 2014. Associations between individual factors and the decision to perform staged PCI were assessed. Additionally, the impact of measured patient and procedural factors, site factors, and unmeasured site factors on the decision to perform staged PCI was compared. Cox proportional hazards models were used to determine the association between staged PCI and mortality. RESULTS: A total of 7,599 patients at 61 sites were included. The decision to perform staged PCI was driven by procedural characteristics and unmeasured site factors. Staged PCI was associated with lower risk-adjusted mortality compared with OTMVR (adjusted hazard ratio [HR]: 0.78; 95% confidence interval [CI]: 0.72 to 0.84; p < 0.01). This mortality benefit was observed among the ST-segment elevation myocardial infarction (HR: 0.31; 95% CI: 0.21 to 0.47; p < 0.01), non-ST-segment elevation myocardial infarction (HR: 0.74; 95% CI: 0.64 to 0.87; p < 0.01), unstable angina (HR: 0.75; 95% CI: 0.64 to 0.89; p < 0.01) and stable angina (HR: 0.88; 95% CI: 0.77 to 1.00; p = 0.05) groups. CONCLUSIONS: The decision to pursue staged PCI was driven by procedural characteristics and unmeasured site variation and was associated with lower mortality compared with OTMVR. After adjustment, there was an association between staged PCI and reduced mortality. Given the observational nature of these findings, a randomized trial comparing the 2 is needed to guide practice.

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Published In

JACC Cardiovasc Interv

DOI

EISSN

1876-7605

Publication Date

November 26, 2018

Volume

11

Issue

22

Start / End Page

2265 / 2273

Location

United States

Related Subject Headings

  • United States Department of Veterans Affairs
  • United States
  • Treatment Outcome
  • Time Factors
  • Risk Factors
  • Risk Assessment
  • Program Evaluation
  • Percutaneous Coronary Intervention
  • Middle Aged
  • Male
 

Citation

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Hu, P. T., Jones, W. S., Glorioso, T. J., Barón, A. E., Grunwald, G. K., Waldo, S. W., … Rao, S. V. (2018). Predictors and Outcomes of Staged Versus One-Time Multivessel Revascularization in Multivessel Coronary Artery Disease: Insights From the VA CART Program. JACC Cardiovasc Interv, 11(22), 2265–2273. https://doi.org/10.1016/j.jcin.2018.07.055
Hu, Peter T., W Schuyler Jones, Thomas J. Glorioso, Anna E. Barón, Gary K. Grunwald, Stephen W. Waldo, Thomas M. Maddox, Mladen Vidovich, Subhash Banerjee, and Sunil V. Rao. “Predictors and Outcomes of Staged Versus One-Time Multivessel Revascularization in Multivessel Coronary Artery Disease: Insights From the VA CART Program.JACC Cardiovasc Interv 11, no. 22 (November 26, 2018): 2265–73. https://doi.org/10.1016/j.jcin.2018.07.055.
Hu PT, Jones WS, Glorioso TJ, Barón AE, Grunwald GK, Waldo SW, et al. Predictors and Outcomes of Staged Versus One-Time Multivessel Revascularization in Multivessel Coronary Artery Disease: Insights From the VA CART Program. JACC Cardiovasc Interv. 2018 Nov 26;11(22):2265–73.
Hu, Peter T., et al. “Predictors and Outcomes of Staged Versus One-Time Multivessel Revascularization in Multivessel Coronary Artery Disease: Insights From the VA CART Program.JACC Cardiovasc Interv, vol. 11, no. 22, Nov. 2018, pp. 2265–73. Pubmed, doi:10.1016/j.jcin.2018.07.055.
Hu PT, Jones WS, Glorioso TJ, Barón AE, Grunwald GK, Waldo SW, Maddox TM, Vidovich M, Banerjee S, Rao SV. Predictors and Outcomes of Staged Versus One-Time Multivessel Revascularization in Multivessel Coronary Artery Disease: Insights From the VA CART Program. JACC Cardiovasc Interv. 2018 Nov 26;11(22):2265–2273.
Journal cover image

Published In

JACC Cardiovasc Interv

DOI

EISSN

1876-7605

Publication Date

November 26, 2018

Volume

11

Issue

22

Start / End Page

2265 / 2273

Location

United States

Related Subject Headings

  • United States Department of Veterans Affairs
  • United States
  • Treatment Outcome
  • Time Factors
  • Risk Factors
  • Risk Assessment
  • Program Evaluation
  • Percutaneous Coronary Intervention
  • Middle Aged
  • Male