Key result
Staged PCI shows no benefit over one-time PCI for 3-year MACE in NSTE-ACS patients.
Why the study?
Does staged PCI improve clinical outcomes compared to 'one-time' PCI in intermediate to very high-risk patients with NSTE-ACS and multivessel disease?
Observational (n=1,531)
No
Does staged PCI improve clinical outcomes compared to 'one-time' PCI in intermediate to very high-risk patients with NSTE-ACS and multivessel disease?
Absolute Event Rate: 20.8% vs 19.7%
p-value: p=0.608
In intermediate to very high-risk NSTE-ACS patients with multivessel disease, a staged PCI strategy significantly reduced the 3-year composite of cardiac death or MI compared to a 'one-time' multivessel PCI strategy.
Staged PCI shows no MACE benefit versus one-time PCI in high-risk NSTE-ACS; leaves open effects on cardiac death/MI and needs randomized trials.
BACKGROUND AND OBJECTIVES: To compare clinical outcomes of staged versus "one-time" percutaneous coronary intervention (PCI) in intermediate to very high-risk patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) and multivessel coronary disease (MVD). SUBJECTS AND METHODS: 1531 NSTE-ACS patients with multivessel PCI and meeting the criteria of intermediate to very high risk were screened from a prospectively registered database obtained from General Hospital of Shenyang Military Region between 2008 and 2012. They were categorized into "one-time" PCI (n=859) and staged PCI (n=672) according to intervention strategy. The primary outcomes included a 3-year major adverse cardiac event (MACE), a composite of cardiac death, myocardial infarction (MI), and target vessel revascularization. RESULTS: At 3 years, no significant differences in MACE (20.8% vs. 19.7%, p=0.608) and cardiac death/MI (7.1% vs. 9.1%, p=0.129) were observed between the two groups. After propensity score matching, there was no statistical significance in MACE (18.9% vs. 21.8%, p=0.249); whereas cardiac death/MI was significantly lower in the staged PCI group (7.0% vs.11.1%, p=0.033). Ninety-day landmark analysis showed that the staged PCI group had a lower 90-day incidence of MACE (1.2% vs. 3.3%, p= 0.037) and cardiac death/MI (0.7% vs. 2.6%, p=0.031). For the 90-day to 3-year follow-up period, the incidences of MACE (17.9% vs. 19.1%, p=0.641) and cardiac death/MI (6.3% vs. 8.7%, p=0.191) were similar in both groups. CONCLUSION: In intermediate- to very high-risk NSTE-ACS patients with MVD, staged PCI is superior to "one-time" PCI in terms of cardiac death/MI.
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Yu et al. (2016) conducted an observational in Non-ST-segment elevation acute coronary syndromes (NSTE-ACS) with multivessel coronary disease (n=1,531). Staged percutaneous coronary intervention (PCI) vs. "One-time" multivessel PCI was evaluated on 3-year major adverse cardiac events (MACE: composite of cardiac death, MI, and target vessel revascularization) (p=0.608). Staged PCI did not significantly reduce the 3-year incidence of major adverse cardiac events compared to one-time PCI (20.8% vs. 19.7%, p=0.608) in intermediate to very high-risk NSTE-ACS patients.
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