Key result
Culprit-only PCI linked to ~2.4-fold higher 3-year MACE risk vs complete revascularization in multivessel NSTEMI.
Why the study?
Patients with NSTEMI and MVD face more adverse clinical outcomes, yet optimal treatment strategies comparing complete revascularization with culprit-lesion-only PCI remained uncertain.
Does complete revascularization reduce major adverse cardiac events at 3 years compared to culprit-lesion-only PCI in patients with NSTEMI and multivessel disease?
Cohort (n=358)
Does complete revascularization reduce major adverse cardiac events at 3 years compared to culprit-lesion-only PCI in patients with NSTEMI and multivessel disease?
Hazard Ratio: 2.412 (95% CI 1.255–4.636)
Absolute Event Rate: 17.7% vs 7.74%
p-value: p=0.008
In patients with NSTEMI and multivessel disease, complete revascularization was associated with a significantly lower 3-year risk of MACE compared to culprit-lesion-only PCI, driven primarily by fewer repeat revascularizations.
May support complete revascularization in NSTEMI multivessel disease; observational data leaves open need for randomized confirmation.
Background The incidence of non-ST-elevation myocardial infarction (NSTEMI) is escalating, with patients diagnosed with multivessel disease (MVD) facing more adverse clinical outcomes. Yet, optimal treatment strategies for NSTEMI patients with MVD remain uncertain. Objectives This study aimed to assess the clinical outcome of NSTEMI patients with MVD who underwent complete revascularization compared to those treated with the culprit lesion only. Methods Between 2014 and 2017, patients presenting with NSTEMI and MVD undergoing successful percutaneous coronary intervention (PCI) were retrospectively included. MVD was defined as patients having more than one lesion considered angiographically significant, exhibiting at least 50% stenosis of the vessel diameter on visual estimation, or having a Coronary Angiography-Derived Fractional Flow Reserve (caFFR) measurement of 0.80 or less. The main exclusion criteria were single vessel disease, and previous coronary-artery bypass grafting surgery. The primary endpoint of this study was major adverse cardiac events (MACE) at 3 years, defined as a composite of cardiac death, myocardial infarction, and ischemia-driven revascularization. Results A total of 358 patients were included (mean age: 67.34±12.77; male: 70.1%), 155 and 203 patients were stratified into complete revascularisation group and culprit-lesion-only PCI group respectively. During 3-year follow-up, the culprit-lesion-only PCI group exhibited a significantly elevated risk of MACE compared to the complete revascularization group (17.7% vs 7.74%; hazard ratio [HR] 2.412, 95% confidence interval [CI] 1.255 - 4.636, P = 0.008). The increase 3-year MACE rate was mainly driven by the higher rate of ischaemia-driven revascularization in the culprit-lesion-only PCI group (11.3% vs 3.23%, HR 3.637, 95% CI 1.383 - 9.566, P = 0.009). Conclusion In NSTEMI patients with MVD, complete revascularization was superior to culprit-lesion-only PCI in mitigating the risk of future MACE at 3 years, which is predominantly attributed by a reduced incidence of repeat revascularisations.
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Kai Hang Yiu (2024) conducted a cohort in Non-ST-elevation myocardial infarction (NSTEMI) with multivessel disease (MVD) (n=358). Culprit-lesion-only PCI vs. Complete revascularization was evaluated on Major adverse cardiac events (MACE) at 3 years (composite of cardiac death, myocardial infarction, and ischemia-driven revascularization) (HR 2.412, 95% CI 1.255-4.636, p=0.008). Culprit-lesion-only PCI increased 3-year MACE risk vs complete revascularization in NSTEMI with multivessel disease (17.7% vs 7.74%; HR 2.412, 95% CI 1.255-4.636; P=0.008).
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