Key result
Culprit-only PCI was associated with a similar risk of major adverse cardiac events at 2 years compared to multivessel PCI (aHR 1.020; p=0.924) in patients with NSTEMI and chronic kidney disease.
Why the study?
Available data are limited regarding clinical outcomes among different reperfusion strategies for multivessel disease treated with newer-generation drug-eluting stents in patients with NSTEMI and CKD.
Does multivessel PCI reduce major adverse cardiac events compared to culprit-only PCI in patients with NSTEMI, multivessel disease, and chronic kidney disease?
Cohort (n=1,042)
Yes
Does multivessel PCI reduce major adverse cardiac events compared to culprit-only PCI in patients with NSTEMI, multivessel disease, and chronic kidney disease?
Hazard Ratio: 1.02
p-value: p=0.924
Culprit-only PCI yields similar 2-year clinical outcomes to multivessel PCI in patients with NSTEMI, multivessel disease, and CKD, and may be preferred to reduce procedure time and contrast-induced nephropathy risk.
Because available data are limited, we compared the 2-year clinical outcomes among different reperfusion strategies (culprit-only percutaneous coronary intervention (C-PCI), multivessel PCI (M-PCI), complete revascularization (CR) and incomplete revascularization (IR)) of multivessel disease (MVD) undergoing newer-generation drug-eluting stent implantation in patients with non-ST-elevation myocardial infarction (NSTEMI) and chronic kidney disease (CKD). In this nonrandomized, multicenter, retrospective cohort study, a total of 1042 patients (C-PCI, n = 470; M-PCI, n = 572; CR, n = 432; IR, n = 140) were recruited from the Korea Acute Myocardial Infarction Registry (KAMIR) and evaluated. The primary outcome was the occurrence of major adverse cardiac events, defined as all-cause death, recurrent myocardial infarction and any repeat coronary revascularization. The secondary outcome was probable or definite stent thrombosis. During the 2-year follow-up period, the cumulative incidences of the primary (C-PCI vs. M-PCI, adjusted hazard ratio (aHR), 1.020; p = 0.924; CR vs. IR, aHR, 1.012; p = 0.967; C-PCI vs. CR, aHR, 1.042; p = 0.863; or C-PCI vs. IR, aHR, 1.060; p = 0.844) and secondary outcomes were statistically insignificant in the four comparison groups. In the contemporary newer-generation DES era, C-PCI may be a better reperfusion option for patients with NSTEMI with MVD and CKD rather than M-PCI, including CR and IR, with regard to the procedure time and the risk of contrast-induced nephropathy. However, further well-designed, large-scale randomized studies are warranted to confirm these results.
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Kim et al. (2021) conducted a cohort in Non-ST-elevation myocardial infarction and chronic kidney disease with multivessel disease (n=1,042). Culprit-only percutaneous coronary intervention (C-PCI) vs. Multivessel PCI (M-PCI) was evaluated on Major adverse cardiac events (all-cause death, recurrent myocardial infarction, and any repeat coronary revascularization) (aHR 1.020, p=0.924). Culprit-only PCI was associated with a similar risk of major adverse cardiac events at 2 years compared to multivessel PCI (aHR 1.020; p=0.924) in patients with NSTEMI and chronic kidney disease.
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