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(Circulation. 2006;113:2380-2382.)
© 2006 American Heart Association, Inc.

Editorial

The Dueling Hazards of Incomplete Revascularization and Incomplete Data

Paul S. Teirstein, MD

From the Division of Cardiovascular Diseases, Scripps Clinic, La Jolla, Calif.

Correspondence to Paul S. Teirstein, MD, Division of Cardiovascular Diseases, Scripps Clinic, 10666 N Torrey Pines Rd, La Jolla, CA 92037. E-mail pteirstein@scrippsclinic.com

Key Words: Editorials • angioplasty • bypass • revascularization • stents

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Although the survival benefit of complete revascularization after bypass surgery is well documented, the importance of opening all stenotic or occluded vessels during percutaneous coronary intervention (PCI) is less certain. On the contrary, much data support targeting only the culprit vessel during PCI. A strategy of "ischemic-driven revascularization" is often the standard of care. Through a potpourri of noninvasive imaging (eg, nuclear imaging, positron emission tomography, stress echocardiography), as well as invasive techniques (eg, fractional flow reserve, intravascular ultrasound measurements, quantitative angiography), much effort has gone into identifying the functional importance of coronary blockages and confining intervention to diseased vessels that significantly limit blood flow to viable myocardium.^1,2 Indeed, the phrase oculostenotic reflex was invented to describe the indiscriminate interventionalist, bent on opening any suspicious angiographic blockage. This subcortical reflex has long been considered a liability, and interventionalists are taught to be more cerebral in their decision making. In this issue of Circulation, Hannan et al, in a very provocative report, use data from the New York State reporting system to turn decades of teaching on its ear.³ Using a database created from a State of New York reporting registry, procedural information was collected on 21 945 patients with 2-vessel coronary artery disease undergoing stenting. Then, using patient’s Social Security numbers, these in-hospital data were correlated with the New York State Vital Statistics Death File to capture mortality events over a follow-up period of &3 years. The study found that patients with incomplete revascularization (after adjustment for baseline differences) . . . [Full Text of this Article]

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