Key result
In a propensity-matched analysis, staged PCI did not significantly reduce the 3-year primary composite endpoint of cardiac death, MI, and TVR compared to one-time PCI (18.9% vs. 21.8%, p=0.249).
Why the study?
Does staged PCI reduce the composite of cardiac death, MI, and TVR compared to one-time PCI in intermediate to very high risk multivessel NSTE-ACS patients?
Does staged PCI reduce the composite of cardiac death, MI, and TVR compared to one-time PCI in intermediate to very high risk multivessel NSTE-ACS patients?
Absolute Event Rate: 18.9% vs 21.8%
p-value: p=0.249
In intermediate to very high risk multivessel NSTE-ACS patients, a staged PCI strategy may reduce the risk of cardiac death and MI compared to a one-time PCI strategy.
Patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS) often have multiple non-culprit lesions in addition to culprit lesion. 1)2) Previous studies suggest that performing "one-time" interventions to non-culprit lesions of multivessel NSTE-ACS patients improve clinical outcomes as compared to culprit-only intervention. 3)4) Shishehbor et al. p=0.004) compared to culprit only PCI strategy. Most of the benefits were driven by reduction in revascularization (HR 0.59, 95% CI 0.41-0.84, p=0.003) and there was no statistically significant difference in the rate of death or composite of death and MI. In the study reported by Kim et al., p=0.031), death or myocardial infarction (HR 0.58, 95% CI 0.35-0.97, p=0.037), and non-target vessel revascularization (HR 0.44, 95% CI 0.24-0.81, p=0.008) compared to culprit only, staged PCI strategy.
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Kim et al. (2016) conducted an editorial in Multivessel Non-ST Segment Elevation Acute Coronary Syndrome (NSTE-ACS) (n=1,531). Staged percutaneous coronary intervention (PCI) vs. One-time PCI was evaluated on Composite of 3-year cardiac death, myocardial infarction (MI), and target vessel revascularization (TVR) (p=0.249). In a propensity-matched analysis, staged PCI did not significantly reduce the 3-year primary composite endpoint of cardiac death, MI, and TVR compared to one-time PCI (18.9% vs. 21.8%, p=0.249).
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