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Long-term clinical outcomes after treatment of stent restenosis with two drug-coated balloons Effect of orbital atherectomy in calcified coronary artery lesions as assessed by optical coherence tomography Comparison of the safety and efficacy of two types of drug-eluting balloons (RESTORE DEB and SeQuent® Please) in the treatment of coronary in-stent restenosis: study protocol for a randomized controlled trial (RESTORE ISR China) Percutaneous Pulmonary Angioplasty for Patients With Takayasu Arteritis and Pulmonary Hypertension Percutaneous coronary intervention with drug-coated balloon-only strategy in stable coronary artery disease and in acute coronary syndromes: An all-comers registry study Procedural Success and Outcomes With Increasing Use of Enabling Strategies for Chronic Total Occlusion Intervention In-Hospital Outcomes of Chronic Total Occlusion Percutaneous Coronary Interventions in Patients With Prior Coronary Artery Bypass Graft Surgery The European bifurcation club Left Main Coronary Stent study: a randomized comparison of stepwise provisional vs. systematic dual stenting strategies (EBC MAIN) Percutaneous Treatment and Outcomes of Small Coronary Vessels: A SCAAR Report Angiographic quantitative flow ratio-guided coronary intervention (FAVOR III China): a multicentre, randomised, sham-controlled trial

Review ArticleVolume 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

ABSTRACT

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.