Complete and incomplete revascularization: Whose definition is it anyway?

Excerpt

Management of significant coronary artery disease is comprised of medical management, whereby risk factors are addressed, and coronary revascularization. The data regarding the survival benefits afforded by emergent coronary revascularization of the culprit vessel in ST elevation myocardial infarction (STEMI) are robust and irrefutable.1 Revascularization in stable patients with chest pain and the factors guiding it is certainly more contentious. Boden et al,2 in their landmark, COURAGE trial, showed that despite objective evidence of ischaemia, revascularization with bare metal stents in the patients of the per-cutaneous coronary intervention (PCI) plus optimal medical therapy arm did not provide any survival benefit when compared to optimal medical therapy alone. It is also important to note that target revascularization was always attempted and complete revascularization was undertaken where clinically appropriate in the PCI arm. They concluded that revascularization could be delayed without adverse outcomes in this group of patients with stable heart disease even with evidence of ischaemia in the medium term. …