Review Article
Volume 74, Issue 25, December 2019
JOURNAL：J Am Coll Cardiol.
Article Link
Limitations of Repeat Revascularization as an Outcome Measure
P Lamelas, J Belardi, R Whitlock et al.
KEYWORDS
CABG; coronary artery disease; PCI; revascularization
Repeat revascularization is a commonly used outcome measure in trials
comparing percutaneous coronary intervention and coronary artery bypass
graft surgery, and differences in this outcome often drive the relative
risk for the primary endpoint. However, repeat revascularization as an
outcome measure has important limitations that complicates its
meaningful interpretation, including confounding by indication (driven
by varying use of stress testing and thresholds for invasive
angiography), differential likelihood of revascularization after graft
versus stent failure, uncertainty of the prognostic impact of repeat
revascularization, and patient preferences and appraisal of the import
of repeat revascularization. Knowledge of these issues will result in
better appreciation of the utility of repeat revascularization as a
clinically meaningful outcome measure. The authors describe these issues
and provide recommendations for the use and assessment of repeat
revascularization as an endpoint when comparing different
revascularization modalities.
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