The 5-year multivariate analysis produced similar results. It identified nine baseline factors that each significantly linked with a significantly increased rate of revascularization during 5-year follow-up: class I or II stable angina, class III or IV stable angina, unstable angina, systolic blood pressure of 101-120 mm Hg, a systolic pressure of 100 mm Hg or less, a blood triglyceride level of 100 mg/dL or greater, proximal LAD disease, having two diseased coronary regions, or having three diseased coronary regions. The increased rates associated with these features ranged from a 90% increased revascularization rate (in patients with class III or IV stable angina, compared with patients without angina), to a 28% increased revascularization rate (in patients with class I or II stable angina at baseline). Again, none of these increased rates appeared to justify uniform, upfront revascularization, Dr. Krone said.
The sole exception to this approach might possibly be the small number of patients who initially presented with both proximal LAD disease and either class III or IV stable angina or unstable angina, because eventually over 5 years 71% of these patients underwent revascularization. But these patients constituted only 2% of the total group studied, Dr. Krone noted. In general, more severe angina or stenosis was uncommon in these patients: Some 41% had no angina and 45% had class I or II angina at baseline, and 87% were free of proximal LAD disease at baseline.
'These results give us confidence that you don't need to intervene on every tight lesion.'
Source DR. KRONE