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Incomplete revascularization after PCI: Staying away from large residuals

Since the beginning of coronary artery bypass grafting (CABG) in 1968, the need for a complete coronary artery revascularization has been under continuous scrutiny. Many reports demonstrated that patients who underwent incomplete revascularization (IR) with either percutaneous coronary intervention (PCI) or CABG had an increase risk of death, myocardial infarction, and repeat revascularization compared to their counterparts [1]. Alternatively, two randomized revascularization trials [The Bypass Angioplasty Revascularization Investigation (BARI) and The Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) 4year] in addition to a recently reported large Asian multicentre registry failed to show an excess risk with IR [2]. The controversy regarding the risk of IR is likely due to the interplay of various factors: