Key result
1-stage multivessel revascularization reduced 3-year major cardiovascular events compared with culprit-only revascularization, with no difference versus multistage MVR.
Why the study?
Few studies have investigated optimal revascularization strategies in non-ST-segment-elevation myocardial infarction with multivessel disease.
Does multivessel revascularization (1-stage or multistage) reduce major adverse cardiac events compared to culprit-only revascularization in patients with NSTEMI and multivessel disease?
Observational
Yes
Does multivessel revascularization (1-stage or multistage) reduce major adverse cardiac events compared to culprit-only revascularization in patients with NSTEMI and multivessel disease?
In NSTEMI patients with multivessel disease without cardiogenic shock, multivessel revascularization (either 1-stage or multistage) reduces 3-year MACE compared to culprit-only revascularization.
Answers are grounded in this paper and cite their sources.
Multivessel revascularization was associated with lower 3-year MACE than culprit-only in NSTEMI; leaves open optimal staging strategy pending randomized confirmation.
Background Few studies have investigated optimal revascularization strategies in non–ST‐segment–elevation myocardial infarction with multivessel disease. We investigated 3‐year clinical outcomes according to revascularization strategy in patients with non–ST‐segment–elevation myocardial infarction and multivessel disease. Methods and Results This retrospective, observational, multicenter study included patients with non–ST‐segment–elevation myocardial infarction and multivessel disease without cardiogenic shock. Data were analyzed at 3 years according to the percutaneous coronary intervention strategy: culprit‐only revascularization (COR), 1‐stage multivessel revascularization (MVR), and multistage MVR. The primary outcome was major adverse cardiac events (MACE: a composite of all‐cause death, nonfatal spontaneous myocardial infarction, or any repeat revascularization). The COR group had a higher risk of MACE than those involving other strategies (COR versus 1‐stage MVR; hazard ratio, 0.65; 95% CI, 0.54–0.77; P <0.001; and COR versus multistage MVR; hazard ratio, 0.74; 95% CI, 0.57–0.97; P =0.027). There was no significant difference in the incidence of MACE between 1‐stage and multistage MVR (hazard ratio, 1.14; 95% CI, 0.86–1.51; P =0.355). The results were consistent after multivariate regression, propensity score matching, inverse probability weighting, and Bayesian proportional hazards modeling. In subgroup analyses stratified by the Global Registry of Acute Coronary Events score, 1‐stage MVR lowered the risk of MACE compared with multistage MVR in low‐to‐intermediate risk patients but not in patients at high risk. Conclusions MVR reduced 3‐year MACE in patients with non–ST‐segment–elevation myocardial infarction and multivessel disease compared with COR. However, 1‐stage MVR was not superior to multistage MVR for reducing MACE except in low‐to‐intermediate risk patients.
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Kim et al. (2020) conducted an observational in Non-ST-segment-elevation myocardial infarction with multivessel disease. 1-stage and multistage multivessel revascularization vs. Culprit-only revascularization was evaluated on Major adverse cardiac events (MACE: a composite of all-cause death, nonfatal spontaneous myocardial infarction, or any repeat revascularization) (HR 0.65, 95% CI 0.54-0.77, p=<0.001). 1-stage multivessel revascularization reduced 3-year major cardiovascular events compared with culprit-only revascularization, with no difference versus multistage MVR.
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