Reasonable incomplete revascularization.

Incomplete coronary artery revascularization could increase the risk of death, myocardial infarction, repeat revascularization, and lifestyle-limiting angina. Data to support this hypothesis extend back to the early 1980s, when patients with incomplete surgical revascularization had an absolute 15% reduction in 5-year survival in comparison with patients with complete revascularization.1,2 This hypothesis should extend to percutaneous coronary intervention (PCI). Two New York State registry analyses demonstrated an increased risk of death associated with incomplete stent-based revascularization, and the Arterial Revascularization Therapies Study (ARTS) trial described a greater need for subsequent bypass surgery after incomplete stent revascularization.3–5 One study has linked incomplete stent-based revascularization with impaired improvement in left ventricular function, and thus suggests a mechanism for increased mortality risk.6