A-32 | Nationwide Analysis of the Outcomes of Multivessel PCI versus Culprit Vessel-Only PCI in Patients With NSTEMI: A Nationwide Retrospective Observational Study

Several randomized controlled trials have indicated that multivessel percutaneous coronary intervention (PCI) in patients with STEMI is associated with improved outcomes, including lower mortality, when compared to culprit vessel–only PCI. The aim of this study was to compare in-hospital outcomes of multivessel versus culprit vessel-only PCI in patients with NSTEMI. Data was obtained from the Nationwide Inpatient Sample from January 2016 to December 2020. The study included adult patients with a principal discharge diagnosis of NSTEMI who underwent PCI during hospitalization. They were divided into multivessel PCI and culprit vessel-only PCI. The primary outcome was inpatient mortality. Secondary outcomes were cardiogenic shock, cardiac arrest, arrhythmias, as well as the need for ventilators, ECMO, pressors and dialysis. 448,424 hospitalizations with NSTEMI were analyzed of which 172,665 underwent PCI. Among them, 138,184 (80%) underwent culprit vessel PCI and 34,481 (20%) underwent multivessel PCI. Culprit vessel-only PCI was associated with lower in-hospital mortality (1.5% vs 2.3%, aOR: 0.7; 95% CI: 0.64-0.76, p<0.001); when adjusted for age, race, sex, and Charlson comorbidity index. Patients with culprit vessel PCI were also associated with lower LOS (3 days vs. 4 days, p< 0.001), and lower total hospital charges ($102,434 vs $139,348, p<0.001) than multivessel PCI. Furthermore, they had a lower risk of cardiogenic shock (2.8% vs 4.7%, aOR: 0.6; 95% CI: 0.58-0.65, p< 0.001), cardiac arrest (1.4% vs 1.8%, aOR: 0.85; 95% CI: 0.77-0.93, p< 0.001), and ventricular arrhythmias (5.5% vs 6.2%, aOR:0.9; 95% CI: 0.86-0.95, p< 0.001). They also required lower life-saving treatments like ventilators (aOR:0.6, 95% CI: 0.49-0.87, p <0.005), ECMO (aOR:0.38, 95% CI: 0.28-0.53, p <0.001), pressors (aOR:0.6, 95% CI: 0.58-0.75, p <0.001), dialysis (aOR:0.76, 95% CI: 0.71-0.81, p <0.001). Our finding suggests that multivessel PCI is associated with worse outcomes than culprit vessel PCI in patients with NSTEMI. This is in contrast to the results seen in patients with STEMI. Further research is required to study the long-term outcomes in these patients.