Key result
Single-stage PCI carries no independent mortality risk over multi-stage PCI in multivessel NSTEMI.
Why the study?
The study was conducted to compare short-term and long-term mortality outcomes between single-stage and multi-stage percutaneous coronary intervention strategies in patients with NSTEMI and multivessel disease.
Does single-stage PCI reduce mortality compared to multi-stage PCI in patients with multivessel NSTEMI?
Cohort (n=298)
No
Does single-stage PCI reduce mortality compared to multi-stage PCI in patients with multivessel NSTEMI?
Absolute Event Rate: 14.1% vs 4%
p-value: p=0.005
In patients with multivessel NSTEMI, single-stage complete revascularization is not independently associated with higher total mortality compared to multi-stage PCI, despite higher unadjusted in-hospital mortality.
Single-stage PCI shows no independent mortality link in multivessel NSTEMI; leaves open optimal timing pending randomized trials.
Aim: The aim of this study was to compare the short-term and long-term mortality results of single-stage percutaneous coronary intervention (SS-PCI) and multi-stage percutaneous coronary intervention (MS-PCI) strategies in patients diagnosed with non-ST segment elevation myocardial infarction (NSTEMI) with multivessel disease. Material and Methods: A total of 298 consecutive patients diagnosed with multivessel NSTEMI (71 (23.8%) patients in the SS-PCI group and 227 (76.2%) patients in the MS-PCI group) were included in this study. Data regarding mortality were obtained from the health information system of our institute and national health registry. Results: Although in-hospital mortality rates were found to be significantly higher in univariate analysis in the SS-PCI group compared to the MS-PCI group (14.1% (n=10) vs 4.0% (n=9); p=0.005), it was not independently associated with total mortality in multiple model. Among the parameters predicted mortality determinants, low hemoglobin (odds ratio (OR)=0.485, 95% confidence interval (CI)=0.332-0.708; p=0.002), No-reflow occurrence (OR=6.194, 95% CI=1.310-29.300, p=0.021), not using post dilatation (OR=0.287, 95% CI=0.085-0.970, p=0.045) were independently associated with total mortality. Conclusion: There was no statistical difference in overall mortality between the two study groups in multivessel NSTEMI patients who underwent complete coronary revascularization with the SS-PCI and MS-PCI strategy, while low hemoglobin, No-reflow phenomenon, and not using post-dilatation were found as independent predictors of mortality.
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Alıcı et al. (2021) conducted a cohort in Non-ST segment elevation myocardial infarction (NSTEMI) with multivessel disease (n=298). Single-stage percutaneous coronary intervention (SS-PCI) vs. Multi-stage percutaneous coronary intervention (MS-PCI) was evaluated on Total mortality (p=0.005). Single-stage percutaneous coronary intervention was not independently associated with total mortality compared to multi-stage intervention in multivessel NSTEMI patients, despite a higher univariate mortality rate (14.1% vs 4.0%, p=0.005).
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