Why the study?
In patients with multivessel coronary artery disease, deciding whether to treat only the culprit vessel or perform multivessel revascularisation remains challenging.
Does multivessel percutaneous coronary intervention reduce major adverse cardiac events compared to culprit vessel only intervention in patients with multivessel disease and stable CAD or NSTE-ACS?
Does multivessel percutaneous coronary intervention reduce major adverse cardiac events compared to culprit vessel only intervention in patients with multivessel disease and stable CAD or NSTE-ACS?
Answers are grounded in this paper and cite their sources.
In patients with multivessel disease and stable CAD or NSTE-ACS, multivessel PCI did not significantly reduce the 5-year risk of MACE compared to culprit-vessel only PCI.
OBJECTIVES/BACKGROUND: In patients with multivessel coronary artery disease (MVD) the decision whether to treat a single culprit vessel or to perform multivessel revascularisation may be challenging. The purpose of this study was to evaluate the long-term outcome of multivessel percutaneous coronary intervention (MV-PCI) versus culprit vessel only (CV-PCI) in patients with stable coronary artery disease or non-ST elevation acute coronary syndrome. METHODS: In this dual-centre, prospective, randomised study a total 215 patients with MVD were randomly assigned to MV-PCI or CV-PCI. The primary endpoint was the occurrence of major adverse cardiac events (MACE) including death, myocardial infarction (MI), and repeat revascularisation. Secondary endpoints were the combined endpoint of death or MI, the individual components of the primary endpoint, and the occurrence of stent thrombosis. Patients were followed up to 5 years after enrolment. RESULTS: The occurrence of the primary endpoint was similar at 28% versus 31% in the MV-PCI and CV-PCI group, respectively (hazard ratio [HR] 0.87, 95% confidence interval [CI]: 0.53-1.44, p = 0.59). The rate of repeat revascularisation was 15% versus 24% (HR 0.59, 95% CI 0.32 to 1.11, p = 0.11), whereas definite or probable stent thrombosis occurred in 2% versus 0% (p = 0.44). CONCLUSIONS: In this randomised study comparing the strategies for MV-PCI and CV-PCI in patients with MVD, no difference was found in the occurrence of MACE after 5 years. We observed a numerically higher rate of death or MI and a lower rate of repeat revascularisation after MV-PCI, although these findings were not statistically significant.
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Fagel et al. (2019) studied this question.
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