Key result
Multivessel PCI was associated with a significantly lower risk of CVD death and non-fatal MI compared to culprit-only PCI (4.0% vs. 9.6%; HR 0.37, 95% CI 0.19-0.67, p=0.0008).
Why the study?
The effect of non-culprit lesion PCI on long-term outcomes remained unclear in acute coronary syndrome patients and real-world clinical settings.
Does multivessel PCI reduce the composite of CVD death and non-fatal MI in ACS patients with multivessel coronary artery disease compared to culprit-lesion-only PCI?
Cohort (n=1,109)
No
Does multivessel PCI reduce the composite of CVD death and non-fatal MI in ACS patients with multivessel coronary artery disease compared to culprit-lesion-only PCI?
Hazard Ratio: 0.37 (95% CI 0.19–0.67)
Absolute Event Rate: 4% vs 9.6%
p-value: p=0.0008
In a real-world cohort of ACS patients with multivessel disease, multivessel PCI within 30 days of onset was associated with a significantly lower risk of long-term cardiovascular death and non-fatal MI compared to culprit-only PCI.
Supports multivessel PCI consideration in ACS; extends observational data but leaves randomized confirmation open.
BACKGROUND: Recent clinical trials have shown that percutaneous coronary intervention (PCI) for non-culprit lesions (NCLs) reduces the risk of adverse events in patients with ST-segment elevation myocardial infarction (STEMI), but the effect on long-term outcomes remains unclear in acute coronary syndrome (ACS) patients and a real-world clinical setting. METHODS: A retrospective observational cohort study of ACS patients who underwent primary PCI between April 2004 and December 2017 at Juntendo University Shizuoka Hospital, Japan, was performed. The primary endpoint was the composite of cardiovascular disease death (CVD death) and non-fatal myocardial infarction (MI) during the mean follow-up period of 2.7 years, and a landmark analysis for the incidence of the primary endpoint from 31 days to 5 years between the multivessel PCI group and the culprit only PCI group was performed. Multivessel PCI was defined as PCI including non-infarct-related coronary arteries within 30 days after the onset of ACS. RESULTS: Of the 1109 ACS patients with multivessel coronary artery disease of the current cohort, multivessel PCI was performed in 364 (33.2 %) patients. The incidence of the primary endpoint from 31 days to 5 years was significantly lower in the multivessel PCI group (4.0 % vs. 9.6 %, log-rank p = 0.0008). Multivariate Cox regression analysis showed that multivessel PCI was significantly associated with fewer cardiovascular events (HR 0.37, 95 % CI 0.19-0.67, p = 0.0008). CONCLUSION: In ACS patients with multivessel coronary artery disease, multivessel PCI may reduce the risk of CVD death and non-fatal MI compared to culprit-lesion-only PCI.
No takes yet. Share an insight, caveat, or question.
Yasuda et al. (2023) conducted a cohort in Acute Coronary Syndromes and Multivessel Coronary Artery Disease (n=1,109). Multivessel PCI vs. Culprit only PCI was evaluated on composite of cardiovascular disease death (CVD death) and non-fatal myocardial infarction (MI) (HR 0.37, 95% CI 0.19-0.67, p=0.0008). Multivessel PCI was associated with a significantly lower risk of CVD death and non-fatal MI compared to culprit-only PCI (4.0% vs. 9.6%; HR 0.37, 95% CI 0.19-0.67, p=0.0008).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: