Table 2.
Publications Incorporated in the Systematic Review and Meta‐Analysis
| Name | Country | Year | Study Type | CR Definition | IR Definition | Number of Patients | ACS% | Follow Up Years | CR Prevalence | % Female | Mean Age, y | NOS |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Appleby et al32 | Canada | 2010 | Observational study | Anatomic | Greater than 70% stenosis in epicardial vessel, assessed angiographically at the end of the procedure | 12 662 | 53 | 3.7 | 35 | 28 | 63 | 7 |
| Bourassa et al33 | USA and Canada | 1999 | Post hoc analysis of the BARI trial | Anatomic: Angiographically significant lesions were defined as ≥50% stenosis in a vessel ≥1.5 mm as measured by electronic calipers | NA | 896 | 63 | 5 | 64 | 23 | 62 | 6 |
| Breeman et al34 | Netherlands | 2001 | Post hoc analysis of the CABRI trial | Anatomic: If all lesions were successfully dilated—ie, if there were no remaining lesions with diameter stenosis <50% and incomplete otherwise | NA | 267 | 25 | 1 | 38 | 19 | 61 | 6 |
| Capodanno et al21 | Italy | 2013 | Observational study | Score‐based: The baseline SYNTAX score and residual SYNTAX score were derived from the summation of the individual scorings for each lesion (defined as ≥50% stenosis in vessel ≥1.5 mm) on angiograms | Residual SYNTAX score >1 | 400 | 62 | 2 | 48.75 | 23 | 67 | 6 |
| Chung et al35 | Korea | 2012 | Observational study | Anatomic: Absence of diameter stenosis ≥50% in major epicardial coronary arteries or their side branches with a diameter ≥2.5 mm after successful PCI during index admission irrespective of the function or viability of relevant myocardium | NA | 845 | 28 | 3.9 | 66.3 | 36.8 | 64 | 6 |
| D'Oliveira Vieira et al36 | Brazil | 2012 | Post hoc analysis of the MASS II trial | Anatomic | NA | 192 | 0 | 10 | 36 | 33 | 59 | 8 |
| Deligonul et al37 | USA | 1988 | Observational study | Anatomic: Successful dilation of all major coronary or branch vessels and absence of residual stenosis ≥50% in a major coronary vessel | NA | 397 | 49 | 2 | 59 | 24 | NA | 6 |
| Gao et al7 | China | 2013 | Observational study | Anatomic: Angiographic CR, which entailed successful angioplasty of all diseased lesions in the major epicardial coronary vessels and their first‐degree side branches (diameter ≥2.5 mm) | Patients not meeting the definition of CR were defined as having IR divided into 4 subgroups: (1) 1 IR vessel with no total occlusion; (2) 1 IR vessel with total occlusion; (3) ≥2 IR vessels with no total occlusion; and (4) 2 IR vessels with total occlusion | 7065 | 61.2 | 1.3 | 16.8 | 20.94 | 58 | 7 |
| Généreux et al6 | Multicenter | 2015 | Post hoc analysis of the SYNTAX trial | Score‐based: The baseline SYNTAX score and residual SYNTAX score were derived from the summation of the individual scorings for each lesion (defined as ≥50% stenosis in vessel ≥1.5 mm) on angiograms |
The SYNTAX Revascularization Index was calculated with the following formula: (Δ SS/baseline SYNTAX score×100). Classified into SRI=100%, SRI 50% to <100%, and SRI <50% |
903 | 28.5 | 5 | 43.5 | 23.7 | 65 | 8 |
| Hambraeus et al13 | Sweden | 2016 | Observational study | Anatomic | Defined as any nontreated significant (at least 60%) stenosis in a coronary artery supplying >10% of the myocardium | 23 342 | 80 | 1 | 35 | 27.2 | 68.1 | 7 |
| Hannan et al4 | USA | 2006 | Observational study | Anatomic: Defined as attempting all lesions with ≥50% stenosis in major epicardial coronary vessels (proximal, mid, and distal right coronary artery, left anterior descending, and left circumflex) either during the index hospitalization or any time within 30 days after discharge from the index hospitalization but before suffering a new myocardial infarction | Patients not meeting the definition of CR were defined to have IR | 21 945 | NA | 3 | 31 | 31 | NA | 6 |
| Hannan et al38 | USA | 2009 | Observational study | Anatomic: Defined as successfully attempting all diseased (≥70% stenosis) lesions in major epicardial coronary vessels (proximal, mid, and distal segments; major left anterior descending diagonals; and circumflex marginal branches) with PCI either during the index hospitalization or at any time within 30 days after discharge from the index hospitalization for PCI but before suffering a new MI. Success was defined as a reduction in stenosis of at least 20% and a residual stenosis of less than 50% | Patients not meeting the definition of CR were defined to have IR | 11 294 | 37 | 1.5 | 31 | 33 | NA | 6 |
| Ijsselmuiden et al9 | Netherlands | 2004 | RCT | Anatomic: Randomly assigned to undergo PCI of either the coronary artery thought to be responsible for ischemia (culprit vessel) or of all ≥50% stenosis (CR) | 219 | 37 | 5 | 50 | 26 | 62 | 9 | |
| Kobayashi et al18 | Multicenter | 2016 | Post hoc analysis of FAME trial | Score‐based: The baseline SYNTAX score and residual SYNTAX score were derived from the summation of the individual scorings for each lesion (defined as ≥50% stenosis in vessel ≥1.5 mm) on angiograms | Residual SYNTAX score of 0, >0 to 4, >4 to 8, and >8, and with SYNTAX revascularization index of 100%, 50% to <100%, and 0% to <50% | 427 | 31.9 | 2 | 14.5 | 25.5 | 64.7 | 8 |
| Kim et al39 | Korea | 2011 | Observational study | Anatomic: Angiographic CR‐1, according to the SYNTAX classification, was defined as angioplasty or grafting in all diseased coronary segments (≥1.5 mm), consisting of the right coronary artery (segments 1, 2, and 3) and its main branches, including the posterior descending artery (segment 4 or 15) and the posterolateral branch (segment 16); the left anterior descending artery (segments 5, 6, 7, and 8) and its major diagonal branches (segment 9 or 10); and the left circumflex artery (segments 11 and 13) and its major obtuse marginal branches (segment 12 or 14). Angiographic CR‐2 was defined as revascularization in all diseased segments ≥2.5 mm in diameter | Patients not meeting these criteria were considered IR patients | 1400 | 42 | 5 | 41 | 29 | 61 | 6 |
| Kip et al40 | USA | 1999 | Post hoc analysis of the BARI trial | Anatomic: Angiographically significant lesions were defined as >50% stenoses in a vessel >1.5 mm, as measured by electronic calipers. A reduction in stenosis of ≥20% with residual stenosis of <50% and TIMI grade 3 flow defined successful lesion dilation | 2047 | NA | 5 | 59 | NA | 61 | 6 | |
| Kloeter et al41 | Switzerland | 2001 | Observational study | Anatomic: No remaining main coronary artery stenosis of >50% | 250 | NA | 2.5 | 60 | 18 | 59 | 6 | |
| Malkin et al22 | United Kingdom | 2013 | Observational study | Score‐based: SYNTAX score and residual SYNTAX score were derived from the summation of the individual scorings for each lesion (defined as ≥50% stenosis in vessel ≥1.5 mm) on angiograms | Residual SYNTAX score of >0 | 353 | 53 | 3.4 | 48.7 | NA | 68 | 7 |
| Malkin et al23 | United Kingdom | 2013 | Observational study | Score‐based: SYNTAX score and residual SYNTAX score were derived from the summation of the individual scorings for each lesion (defined as ≥50% stenosis in vessel ≥1.5 mm) on angiograms | Residual SYNTAX score of >0 | 240 | 38 | 2.6 | 41 | 26 | 66.9 | 7 |
| Mariani et al71 | Italy | 2001 | Observational study | Anatomic: Defined as successful management of all significant stenoses in major epicardial vessels, whereas IR was defined as the residual presence of >50% stenosis in a major segment after the procedure | 208 | 100 | 1 | 24 | 17 | 63 | 6 | |
| Nikolsky et al42 | Israel | 2004 | Observational study | Anatomic | NA | 658 | 22 | 3 | 27 | 27 | 61 | 6 |
| Norwa‐Otto et al43 | Poland | 2010 | Observational study | Functional: CR was defined as successful PCI of all coronary artery lesions with significant narrowing not fulfilling the above criteria | Functionally driven IR was defined as dilation of all segments with >70% stenosis, with the exception of arteries supplying an area of previous transmural MI or a small amount of myocardium | 908 | 33 | 11 | 31 | 18 | 52 | 6 |
| Park et al17 | Korea | 2014 | Observational study | Score‐based: The baseline SYNTAX score and residual SYNTAX score were derived from the summation of the individual scorings for each lesion (defined as ≥50% stenosis in vessel ≥1.5 mm) on angiograms | Residual SYNTAX score of 0, >0 to <7, and >7 | 5088 | 64.5 | 1 | 42.7 | 32 | 62 | 7 |
| Rosner et al8 | USA | 2012 | Post‐hoc analysis of ACUITY trial | Anatomic | Was variably defined as any lesion with a final DS ranging from ≥30% to ≥70% (in 10% increments) with a reference vessel diameter (RVD) ≥2.0 mm by QCA was left untreated after PCI in any epicardial coronary artery | 2954 | 100 | 1 | 63 | 31 | 60 | 8 |
| Sarno et al44 | The Netherlands | 2010 | Post‐hoc analysis of the ARTS‐II Study) | Anatomic: Patients were considered to have CR if all lesions with >50% diameter stenosis had been successfully treated | Those patients in whom attempt was made to treat 1 significant lesion or whose treatment resulted in a final diameter stenosis >50% were considered to have IR | 567 | 45 | 5 | 61.2 | 23 | 62.5 | 6 |
| Sohn et al20 | Korea | 2014 | Observational study | Anatomic: CR was defined as the absence of ≥70% diameter stenosis in major epicardial coronary arteries or their branches with a diameter ≥2.0 mm after successful PCI | 263 | 29 | 3.3 | 57 | 25.8 | 67 | 6 | |
| Song et al45 | Korea | 2012 | Observational study | Anatomic: CR strategy was defined as attempting all lesions with >50% stenosis in major epicardial coronary vessels and their major branches during the index hospitalization | 873 | 48 | 1.5 | 48.9 | 30 | 64 | 6 | |
| Srinivas et al46 | USA | 2007 | Observational study | Anatomic: CR required that at least 1 lesion had to be treated in each of the major territories with diameter stenosis >50% | 1406 | 36.5 | 1 | 22 | 33 | 62 | 6 | |
| Tamburino et al47 | Italy | 2008 | Observational study | Anatomic: Revascularization was defined as complete, when all lesions with >50% diameter stenosis located in segment of at least 2.25 mm diameter, by quantitative coronary analysis, were successfully treated either during the index hospitalization or staged electively within 3 months after the initial procedure | 508 | 50 | 3 | 42 | 21 | 62 | 7 | |
| Valenti et al48 | Italy | 2008 | Observational study | Anatomic: CR was defined as a restoration of TIMI grade 3 flow with residual stenosis <30% on visual assessment in the 3 coronary arteries and their major branches (branch diameter ≥2 mm) | 486 | 37.5 | 2 | 62 | 17 | 68 | 6 | |
| Van den Brand et al31 | Multicenter | 2002 | Post‐hoc analysis of the ARTS Trial | Anatomic: if all lesions of ≥50% diameter stenosis had been successfully treated | If no attempt was made to treat 1 or more significant lesions, or if treatment resulted in a final diameter stenosis ≥50%, these patients were considered to be incompletely revascularized | 576 | 38 | 1 | 70 | 21 | 61.5 | 8 |
| Wu et al5 | USA | 2011 | Observational study | Anatomic: Revascularization was defined as reduction of stenosis to <50% in all diseased (≥70% stenosis) lesions in major epicardial coronary vessels (left anterior descending artery and major diagonals; left circumflex artery and large marginal branches; and right coronary artery and right posterior descending artery) in the index hospitalization or within 30 days after discharge from the index hospitalization before having a new MI. However, if the patient had an MI before the CR was completed, this was not regarded as CR because of the occurrence of an adverse event before CR was attained | When a CR was not achieved during a stenting procedure, it was defined as a procedure with IR. | 13 016 | NA | 8 | 30 | 31 | NA | 6 |
| Wu et al24 | USA | 2013 | Observational study | Anatomic: CR was defined when the postprocedural stenosis in each of the lesions was reduced to <50% in the index hospitalization or within 30 days in staged PCI procedures following discharge from the index hospitalization before the occurrence of a new MI | When CR was not achieved after the stenting procedure in the index admission or within 30 days of discharge, the revascularization was defined as IR | 21 767 | NA | 5 | 31.4 | 33.5 | NA | 7 |
| Yang et al49 | China | 2010 | Observational study | Anatomic: Clinical lesions were defined as >50% stenosis of a main coronary artery or >70% stenosis of its primary branches. The definition of CR was the treatment of all lesions in the main coronary artery and primary branches | Incomplete coronary revascularization (ICR) was defined as treatment of main culprit lesions but not other clinical lesions | 324 | 92 | 1.5 | 22 | 22 | 61 | 6 |
| George et al50 | UK | 2014 | Observational study | Successful PCI to the target CTO and postprocedural obstruction of <50% in all major epicardial coronary arteries | Successful PCI to the target CTO but with residual obstruction of >50% in ≥1 other vessels | 13 443 | NA | 2.65 | NA | 21 | 63.5 | 6 |
| Hannan et al51 | USA | 2016 | Observational study | Defined as a residual stenosis of <50% for all lesions with preprocedural stenoses of at least 70%. The reference category for the variable was successful CTO PCI and CR of all other lesions with preprocedural stenosis of at least 70%. Also, if a CTO or non‐CTO PCI was successful in a staged admission, that patient was regarded as having undergone a successful PCI | NA | 4030 | NA | 1.8 | 61 | 22.4 | 63.2 | 6 |
| Danzi et al52 | Italy | 2013 | Observational study | Defined as a TIMI flow grade 3 with residual stenosis of <30% on visual assessment in the 3 coronary arteries and their major branches (branch diameter of >2 mm) | NA | 120 | 33.3 | 2 | 63.3 | 7.5 | 68 | 6 |
| Chang et al53 | South Korea | 2016 | Prospective cohort study | Absence of diameter stenosis ≥50% in major epicardial coronary arteries or their side branches with a diameter ≥2.5 mm after successful stent implantation during index hospitalization irrespective of the function or viability of relevant myocardium | Not meeting the CR criteria | 3901 | 54.1 | 4.9 | 50 | 30 | 63 | 8 |
ACS indicates acute coronary syndrome; CR, complete revascularization; CTO, chronic total occlusion; IR, incomplete revascularization; NOS, Newcastle‐Ottawa Scale; PCI, percutaneous coronary intervention; SRI, SYNTAX revascularisation index; SYNTAX, Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery; TIMI, thrombolysis in myocardial infarction.