Coronary artery disease (CAD) continues to be a leading cause of morbidity and mortality worldwide, accounting for a substantial proportion of cardiovascular deaths. Among its various presentations, multivessel coronary artery disease (MVD), characterized by significant stenosis in two or more major epicardial coronary arteries, represents a particularly high-risk subgroup. Patients with MVD often present with more extensive atherosclerotic burden, impaired myocardial perfusion, and higher rates of adverse cardiovascular events compared to those with single-vessel disease. Historically, coronary artery bypass grafting (CABG) has been considered the standard of care for patients with multivessel disease, especially in those with diabetes mellitus or complex coronary anatomy. CABG offers the advantage of complete revascularization and has been associated with improved long-term survival in selected populations. However, over the past two decades, percutaneous coronary intervention (PCI) has undergone remarkable advancements, including the introduction of second- and third-generation drug-eluting stents (DES), improved antiplatelet therapy, and the incorporation of intravascular imaging techniques such as intravascular ultrasound (IVUS) and optical coherence tomography (OCT). These developments have significantly enhanced the safety and efficacy of PCI, expanding its applicability in patients with complex coronary lesions. Despite these technological improvements, the optimal revascularization strategy for MVD remains a topic of ongoing debate. One of the key issues is whether PCI can achieve outcomes comparable to CABG, particularly in terms of long-term survival, need for repeat revascularization, and incidence of major adverse cardiovascular events (MACE). Furthermore, the concept of complete versus incomplete revascularization has gained considerable attention. Complete revascularization, defined as the successful treatment of all significant coronary lesions, has been associated with better clinical outcomes, reduced ischemic burden, and improved quality of life. In contrast, incomplete revascularization may leave residual ischemia, potentially leading to recurrent symptoms and adverse events. Recent large-scale randomized trials and meta-analyses, such as the SYNTAX, FREEDOM, and EXCEL trials, have provided valuable insights into the comparative effectiveness of PCI and CABG in multivessel disease. However, real-world data, particularly from diverse patient populations and tertiary care settings, remain essential to better understand the practical outcomes of PCI. In this context, the present study aims to evaluate the clinical outcomes of PCI in patients with multivessel coronary artery disease. Specifically, it focuses on procedural success rates, incidence of MACE, and the impact of complete versus incomplete revascularization on short- and intermediate-term outcomes. By analyzing these parameters, this study seeks to contribute to the growing body of evidence guiding decision-making in the management of complex coronary artery disease.

This study was designed as a prospective observational study conducted at a tertiary care cardiac center over a period of two years, from January 2020 to December 2020. A total of 120 consecutive patients diagnosed with multivessel coronary artery disease (MVD) and undergoing percutaneous coronary intervention (PCI) were included in the study. Multivessel disease was defined as the presence of ≥70% stenosis in two or more major epicardial coronary arteries, as confirmed by coronary angiography. The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki, and institutional ethical committee approval was obtained prior to commencement. Written informed consent was obtained from all participants before inclusion in the study. Patients aged 18 years and above, presenting with stable angina, unstable angina, or non-ST elevation myocardial infarction (NSTEMI), and who were suitable candidates for PCI were included in the study. Patients with significant left main coronary artery disease, cardiogenic shock, prior coronary artery bypass grafting (CABG), severe renal dysfunction, active malignancy, or those unwilling to provide consent were excluded. Baseline demographic data, including age, sex, and cardiovascular risk factors such as hypertension, diabetes mellitus, dyslipidemia, and smoking status, were recorded. Clinical presentation, laboratory parameters, and echocardiographic findings were also documented. All patients underwent coronary angiography using standard techniques. Lesion characteristics, number of vessels involved, and severity of stenosis were assessed by experienced interventional cardiologists. PCI was performed according to current clinical guidelines using standard femoral or radial access. Drug-eluting stents (DES) were used in all patients to minimize the risk of restenosis. Decisions regarding complete or incomplete revascularization were made based on lesion complexity, vessel size, patient stability, and operator discretion. Complete revascularization was defined as successful treatment of all angiographically significant lesions, whereas incomplete revascularization referred to the presence of one or more untreated significant lesions. Periprocedural management included administration of dual antiplatelet therapy consisting of aspirin and a P2Y12 inhibitor (clopidogrel, prasugrel, or ticagrelor), along with anticoagulation using unfractionated heparin during the procedure. Glycoprotein IIb/IIIa inhibitors were used in selected high-risk cases. Procedural success was defined as residual stenosis of less than 20% with Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow and absence of major complications such as dissection, perforation, or acute vessel closure. Patients were followed up clinically at 1 month, 6 months, and 12 months after the procedure. Follow-up data were obtained through outpatient visits and telephonic interviews where necessary. The primary outcome measured was the incidence of major adverse cardiovascular events (MACE), defined as a composite of all-cause mortality, myocardial infarction, and repeat revascularization. Secondary outcomes included procedural success rate and incidence of complications such as bleeding, vascular access complications, and stent thrombosis. Data were entered into a structured database and analyzed using Statistical Package for the Social Sciences (SPSS) software version 25.0. Continuous variables were expressed as mean ± standard deviation, while categorical variables were presented as frequencies and percentages. Comparisons between groups (complete vs incomplete revascularization) were performed using the chi-square test for categorical variables and independent t-test for continuous variables. A p-value of less than 0.05 was considered statistically significant.

Table 1: Baseline Characteristics Parameter Value Mean age (years) 58.4 ± 9.2 Male (%) 72% Diabetes mellitus 48% Hypertension 56% Smokers 42% Table 2: Angiographic Profile Variable Percentage Double vessel disease 45% Triple vessel disease 55% LAD involvement 78% RCA involvement 64% LCX involvement 59% Table 3: Procedural Characteristics Parameter Value Drug-eluting stents used 100% Complete revascularization 68.3% Procedural success rate 95.8% Table 4: Clinical Outcomes (12 months) Outcome Percentage MACE 14.2% Mortality 3.3% Myocardial infarction 4.2% Repeat revascularization 6.7% Table 5: Outcomes Based on Revascularization Outcome Complete (%) Incomplete (%) MACE 8.5% 25.0% Mortality 1.2% 7.5% Repeat PCI 3.6% 12.5%

The findings of the present study highlight the effectiveness and safety of percutaneous coronary intervention in the management of multivessel coronary artery disease. A high procedural success rate of 95.8% was observed, reflecting the advancements in interventional cardiology techniques, operator expertise, and the widespread use of drug-eluting stents. These results are consistent with contemporary studies that demonstrate improved procedural outcomes with modern PCI approaches. One of the most significant observations in this study is the clear benefit associated with complete revascularization. Patients who underwent complete revascularization exhibited significantly lower rates of major adverse cardiovascular events compared to those with incomplete revascularization. This finding reinforces the concept that addressing all hemodynamically significant lesions reduces residual ischemia and improves myocardial perfusion, thereby lowering the risk of adverse outcomes. Similar conclusions have been reported in studies such as the SYNTAX and COMPLETE trials, which emphasize the prognostic importance of achieving complete revascularization whenever feasible. The overall incidence of MACE in this study was 14.2% at 12 months, which is comparable to previously published data. The relatively low mortality rate (3.3%) further supports the safety profile of PCI in multivessel disease. Importantly, the higher rates of repeat revascularization observed in the incomplete revascularization group highlight a key limitation of PCI, particularly in complex lesions where complete intervention may not be achievable due to anatomical or technical constraints. The universal use of drug-eluting stents in this study likely contributed to favorable outcomes by reducing restenosis rates and the need for repeat interventions. Advances in stent design, including thinner struts and improved polymer coatings, have played a critical role in enhancing long-term vessel patency. Additionally, the adjunctive use of dual antiplatelet therapy has further minimized the risk of stent thrombosis, contributing to improved clinical outcomes. Despite these positive findings, certain challenges remain. Patients with diffuse disease, chronic total occlusions, or severe calcification often present technical difficulties that limit complete revascularization. In such cases, hybrid approaches or consideration of surgical revascularization may be more appropriate. Furthermore, patient-specific factors such as diabetes mellitus, left ventricular dysfunction, and comorbid conditions must be carefully evaluated when selecting the optimal treatment strategy. This study has some limitations. The relatively small sample size and single-center design may limit the generalizability of the findings. Additionally, the follow-up period of 12 months may not fully capture long-term outcomes, particularly with respect to late restenosis and survival benefits. Future multicenter studies with larger cohorts and extended follow-up are warranted to validate these results. In conclusion, PCI represents a viable and effective treatment option for patients with multivessel coronary artery disease, particularly when complete revascularization can be achieved. Careful patient selection, meticulous procedural planning, and the use of advanced technologies are essential to optimize outcomes and minimize complications.

Percutaneous coronary intervention is a safe and effective strategy for managing multivessel coronary artery disease. Complete revascularization is associated with significantly improved clinical outcomes, including reduced MACE and mortality. Future studies with larger sample sizes and longer follow-up are required to further validate these findings and optimize treatment strategies.

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