Key result
Percutaneous coronary intervention reduced 24-month mortality by 63% compared to medical-only therapy in a matched population of patients with multivessel coronary artery disease presenting with NSTE-ACS.
Why the study?
Does percutaneous coronary intervention or coronary artery bypass grafting reduce 24-month all-cause death in patients with multivessel CAD presenting NSTE-ACS compared to medical-only therapy?
Cohort (n=1,342)
No
Does percutaneous coronary intervention or coronary artery bypass grafting reduce 24-month all-cause death in patients with multivessel CAD presenting NSTE-ACS compared to medical-only therapy?
In patients with multivessel CAD presenting with NSTE-ACS, revascularization with PCI significantly reduces 24-month mortality compared to medical-only management.
Answers are grounded in this paper and cite their sources.
May support PCI consideration in multivessel NSTE-ACS; leaves open randomized confirmation of mortality benefit.
BACKGROUND: There is paucity of data concerning the optimal revascularization in patients with mul- tivessel coronary artery disease (CAD) presenting non-ST-segment elevation acute coronary syndrome (NSTE-ACS). The aim was to evaluate long-term outcomes of patients with multivessel CAD presenting NSTE-ACS depending on the management after coronary angiography. METHODS: 3,166 patients with NSTE-ACS hospitalized between 2006 and 2014 were screened. After ex- clusions, 1,342 patients were enrolled with multivessel CAD and were divided depending on their man- agement after coronary angiography; the medical-only therapy group (n = 91), the percutaneous coronary intervention (PCI) group (n = 1,122), the coronary artery bypass grafting (CABG) group (n = 129). Propensity scores matching was used to adjust for differences in patient baseline characteristics. RESULTS: After propensity score analysis, 273 well-matched patients were chosen. Both before and after matching, patients treated with a medical-only therapy were burdened with the highest percentage of 24-month all-cause death and non-fatal MI in comparison to PCI and CABG groups, respectively. In the CABG group, ACS-driven revascularization rate was lowest. In the overall population, PCI (HR 0.33; 95% CI 0.20-0.53; p < 0.0001) and CABG (HR 0.54; 95% CI 0.31-0.93; p = 0.028) were independent factors associated with favorable 24-month prognosis. However, in a matched population only PCI was an independent predictor of long-term prognosis with a 63% decrease of 24-month mortal- ity (HR 0.37; 95% CI 0.19-0.69; p = 0.0020). CONCLUSIONS: In patients with multivessel CAD presenting with NSTE-ACS, medical-only man- agement is related with adverse long-term prognosis in contrast to revascularization, which reduces 24-month mortality, especially among patients undergoing percutaneous intervention. Performance of PCI is an independent factor for improving long-term prognosis.
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Desperak et al. (2013) conducted a cohort in Multivessel coronary artery disease presenting non-ST-segment elevation acute coronary syndromes (NSTE-ACS) (n=1,342). Percutaneous coronary intervention (PCI) vs. Medical-only therapy was evaluated on 24-month all-cause death (HR 0.37, 95% CI 0.19-0.69, p=0.0020). Percutaneous coronary intervention reduced 24-month mortality by 63% compared to medical-only therapy in a matched population of patients with multivessel coronary artery disease presenting with NSTE-ACS.
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