Culprit-only versus multivessel or complete versus incomplete revascularization in patients with non-ST-segment elevation myocardial infarction and multivessel disease who underwent successful percutaneous coronary intervention using newer-generation drug-eluting stents. (May 2020)

• Record Type: Journal Article
• Authors: Kim, Yong Hoon; Her, Ae-Young; Jeong, Myung Ho; Kim, Byeong-Keuk; Hong, Sung-Jin; Kim, Seunghwan; Ahn, Chul-Min; Kim, Jung-Sun; Ko, Young-Guk; Choi, Donghoon; Hong, Myeong-Ki; Jang, Yangsoo
• Is Part Of: Atherosclerosis. Volume 301(2020)
• Page Start: 54
• Page End: 64
• Publication Date: 2020-05
• Subjects: Angioplasty -- Non-ST-segment elevation myocardial infarction -- Multivessel disease; Arteriosclerosis -- Periodicals; Electronic journals; 616.136
• DOI: 10.1016/j.atherosclerosis.2020.04.002
• Languages: English
• ISSNs: 0021-9150

Abstract

Abstract: Background and aims: The long-term comparative results between culprit-only percutaneous coronary intervention (C–PCI) and multivessel PCI (M-PCI) or those between complete revascularization (CR) and incomplete revascularization (IR) in patients with non-ST-elevation myocardial infarction (NSTEMI) and multivessel disease (MVD) after successful newer-generation drug-eluting stent (DES) implantation are limited. Therefore, we compared the 2-year clinical outcomes in such patients. Methods: A total of 4588 patients with NSTEMI and MVD (C–PCI, n = 2055; M-PCI, n = 2533; CR, n = 2029; IR, n = 504) were evaluated. The primary outcome was major adverse cardiac events (MACEs) defined as all-cause death, recurrent myocardial infarction MI, and any repeat coronary revascularization. The secondary outcome was stent thrombosis (ST). Results: The cumulative incidences of the primary and secondary outcomes were similar in the three comparison groups (C–PCI vs. M-PCI, CR vs. IR, or CR vs. C–PCI). However, the cumulative incidence of non-target vessel revascularization (non-TVR) was higher in the C–PCI group than in the M-PCI group (adjusted hazard ratio [aHR]: 2.011; 95% confidence interval [CI]: 1.942–3.985; p = 0.012), higher in the IR group than in the CR group (aHR: 2.051; 95% CI: 1.216–4.183; p = 0.043), and higher in the C–PCI group than in the CR group (aHR: 2.099; 95% CI: 1.237–3.564; p = 0.006). Conclusions: Regarding the higher cumulative incidence of non-TVR, M-PCI and CR were preferred compared to C–PCI or IR in patients with NSTEMI and MVD. However, further randomized studies are required to confirm these findings. Graphical abstract: Image 1 Highlights: Debates exist on culprit-only percutaneous coronary intervention (C–PCI) versus multivessel PCI (M-PCI) and complete revascularization (CR) versus incomplete revascularization (IR). Results of these comparisons after newer-generation drug-eluting stent deployment are limited. Incidence rate of non-target vessel revascularization (non-TVR) was significantly higher in the C–PCI and IR group. M-PCI and CR were preferred in patients with non-ST-elevation myocardial infarction (NSTEMI) and multivessel disease (MVD).