Key result
Complete revascularization in multivessel ACS linked to ~61% lower all-cause death versus incomplete revascularization.
Why the study?
To investigate long-term mortality in acute coronary syndrome patients with multivessel disease according to completeness of revascularization and high-bleeding risk status.
Does complete revascularization reduce all-cause death in ACS patients with multivessel disease irrespective of high bleeding risk status?
Cohort (n=209)
Does complete revascularization reduce all-cause death in ACS patients with multivessel disease irrespective of high bleeding risk status?
Hazard Ratio: 0.39 (95% CI 0.22–0.7)
Absolute Event Rate: 4.5% vs 11.5%
p-value: p=0.002
In ACS patients with multivessel disease, achieving complete revascularization is associated with reduced long-term mortality regardless of high bleeding risk status.
CR may warrant consideration in ACS with MVD irrespective of HBR; leaves open need for randomized confirmation of mortality benefit.
Objectives: To investigate the long-term mortality of acute coronary syndrome (ACS) patients with multivessel disease according to the level of completeness of revascularization (CR) and high-bleeding risk (HBR) status. Design Setting and Participants: This retrospective study collected the data of ACS patients with multivessel disease who underwent percutaneous coronary intervention between May 2018 and February 2019. Complete to reasonable revascularization (CR) was defined by the residual Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery score (RSS) of 0 to ≤8. The HBR was defined by the PRECISE-DAPT score ≥25. Main Outcome Measures: The all-cause death at 36 months according to the CR and HBR status. Results: A total of 209 patients with 743 lesions were included in the analysis. The median follow-up was 3.6 years. Patients with CR had lower event rates than ICR (4.5 vs. 11.5 per 100 patient-year, HR 0.39, 95% CI 0.22-0.70), p = 0.002). Similar observations were noted when compared between non-HBR and HBR (3.9 vs. 11.1 per 100 patient-year, HR 0.35, 95% CI 0.18-0.64, p < 0.001). Kaplan-Meier analysis revealed that all-cause death was highest among those in the ICR/HBR (40.5%) followed by ICR/non-HBR (28.6%), CR/non-HBR (28.3%) and the lowest among the CR/HBR group (7.1%), log-rank p = <0.001. No significant interaction was observed between the two factors regarding all-cause death (p = 0.10 for interaction). Conclusions: In ACS patients with MVD, the achievement of CR was associated with reducing mortality rates and consistency irrespective of the HBR status. (Trial Registration: TCTR20211222003).
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Attachaipanich et al. (2024) conducted a cohort in Acute coronary syndrome with multivessel disease (n=209). Complete revascularization vs. Incomplete revascularization was evaluated on All-cause death at 36 months (HR 0.39, 95% CI 0.22-0.70, p=0.002). Complete revascularization in ACS patients with multivessel disease was associated with lower all-cause death compared to incomplete revascularization (HR 0.39; 95% CI 0.22-0.70; p=0.002).
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