Conflict of interest: Nothing to report.
Coronary Artery Disease
Patients with coronary artery disease not amenable to traditional revascularization: Prevalence and 3-year mortality†
Article first published online: 25 JAN 2010
Copyright © 2010 Wiley-Liss, Inc.
Catheterization and Cardiovascular Interventions
Volume 75, Issue 6, pages 886–891, 1 May 2010
How to Cite
Williams, B., Menon, M., Satran, D., Hayward, D., Hodges, J. S., Burke, M. N., Johnson, R. K., Poulose, A. K., Traverse, J. H. and Henry, T. D. (2010), Patients with coronary artery disease not amenable to traditional revascularization: Prevalence and 3-year mortality. Cathet. Cardiovasc. Intervent., 75: 886–891. doi: 10.1002/ccd.22431
- Issue published online: 23 APR 2010
- Article first published online: 25 JAN 2010
- Accepted manuscript online: 25 JAN 2010 12:00AM EST
- Manuscript Accepted: 21 DEC 2009
- Manuscript Received: 15 DEC 2009
- Jon Holden DeHaan Foundation
- refractory angina;
- incomplete revascularization;
- end-stage coronary artery disease
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 = 142) had higher mortality than completely revascularized patients (groups 1–3, n = 351): 14.8 vs. 6.6% (P = 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 = 0.004) when compared with completely revascularized patients. © 2010 Wiley-Liss, Inc.