Key result
No index revascularization is linked to higher in-hospital MACE, though driven by confounding by indication.
Why the study?
Real-world data comparing treatment strategies and in-hospital outcomes across no index revascularization, PCI, and CABG in NSTEMI patients remain limited.
Does revascularization (PCI or CABG) reduce in-hospital MACE compared to no index revascularization in NSTEMI patients undergoing coronary angiography?
Cohort (n=1,906)
No
Does revascularization (PCI or CABG) reduce in-hospital MACE compared to no index revascularization in NSTEMI patients undergoing coronary angiography?
Absolute Event Rate: 9.8% vs 3.5%
p-value: p=<0.001
In NSTEMI patients undergoing angiography, the higher in-hospital MACE rate observed in those not receiving revascularization is driven primarily by their higher baseline clinical risk rather than the absence of revascularization itself.
Higher unadjusted MACE in medically managed NSTEMI warrants interpretive caution; confirms confounding by baseline risk and leaves open causal inference.
Background/Objectives: Real-world data comparing treatment strategies and in-hospital outcomes across no index revascularization, percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG) in NSTEMI patients remain limited. Methods: In this single-center retrospective cohort study, 1906 NSTEMI patients undergoing coronary angiography were categorized into no index revascularization (n = 946), PCI (n = 709), or CABG (n = 251) groups. The primary endpoint was in-hospital major adverse cardiovascular events (MACE), defined as all-cause mortality, cardiac arrest requiring cardiopulmonary resuscitation, sustained ventricular tachycardia/ventricular fibrillation, dialysis-requiring acute kidney injury, or stroke. Missing data were handled using multiple imputation with chained equations (MICE), and propensity score-based inverse probability of treatment weighting (IPTW) was used as a sensitivity analysis. Results: In-hospital MACE was higher in the no index revascularization group than in the PCI and CABG groups (9.8% vs. 3.5% vs. 4.8%; p < 0.001). Patients managed with no index revascularization were older and had a greater comorbidity burden, lower left ventricular ejection fraction, and more frequent Killip class ≥ 2. In the primary multivariable model, chronic kidney disease, Killip class ≥ 2, lower LVEF, CRP, and male sex were associated with in-hospital MACE, whereas neither PCI nor CABG strategy was independently associated with MACE. IPTW sensitivity analyses yielded similar directions of association; however, the PCI estimate crossed the conventional significance threshold after 1st–99th percentile weight truncation. Conclusions: Patients managed with no index revascularization had a higher baseline risk profile and higher unadjusted in-hospital MACE and mortality. The observed between-group differences should be interpreted as associations rather than causal effects of treatment strategy because of substantial confounding by indication.
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Erdoğan et al. (2026) conducted a cohort in NSTEMI (n=1,906). No index revascularization vs. PCI or CABG was evaluated on In-hospital major adverse cardiovascular events (MACE) (p=<0.001). Unadjusted in-hospital MACE was higher with no index revascularization versus PCI or CABG (9.8% vs. 3.5% vs. 4.8%; P<0.001), though differences were driven by substantial confounding by indication.
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