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Revascularization strategy in patients with multivessel disease and a major vessel chronically occluded; data from the CABRI trial

^a Department of Cardiology, University of Rome "Tor Vergata", Italy
^b Department of Cardiac Surgery, University of Rome "La Sapienza", Italy

Received 30 May 2007; received in revised form 21 August 2007; accepted 27 September 2007.

^_* Corresponding author. Address: University of Rome "Tor Vergata", Department of Cardiology, Viale Oxford 81, 00133 Rome, Italy. Tel.: +39 0620903996; fax: +39 0620904043. (Email: e.martuscelli{at}libero.it).

Objective: In patients with multivessel coronary artery disease and total occlusion of major epicardial vessel, completeness of revascularization has not been investigated in specific trials comparing the surgical and the percutaneous revascularization strategy. Analyzing the database of the CABRI study, which randomized a substantial number of these patients, we investigated the long-term effects of a successful or unsuccessful revascularization of the occluded vessel and completeness of the revascularization. Methods and results: The CABRI study randomized 1054 patients with multivessel coronary disease to coronary bypass or to coronary angioplasty. From the database of this trial, we selected patients with a major vessel chronically occluded (103 in the bypass group and 120 in the angioplasty group). At a median follow-up of 30 months, the incidence of death or Q-wave myocardial infarction (combined end point) was significantly lower in the bypass group than in the angioplasty group (6.8% vs 17.5%, respectively; hazard ratio [HR], 0.42 [95% CI 0.17–0.98]; p = 0.047). On univariate analysis, age, proximal occlusion, complete revascularization, revascularization of the occluded vessel and revascularization procedure were identified as significant predictors of combined end points. On multivariate analysis, independent predictors of combined end points resulted in completeness of revascularization (HR 0.26; 95% CI 0.09–0.76; p = 0.01) and age (HR 1.07; 95% CI 1.02–1.12; p < 0.01). Conclusion: In patients with multivessel coronary disease and chronic occlusion of a major epicardial vessel, achieving of a complete revascularization by reopening or bypassing the occluded vessel is associated with a significantly better long-term prognosis.

Key Words: Incomplete revascularization • Percutaneous coronary angioplasty • Coronary artery bypass • Chronic coronary occlusion