Timing of Complete Multivessel Revascularization in Patients Presenting With Non-ST-Segment Elevation Acute Coronary Syndrome

被引：7

作者：

Elscot, Jacob J. ^{[1
]}

Kakar, Hala ^{[1
]}

Scarparo, Paola ^{[1
]}

Dekker, Wijnand K. den ^{[1
]}

Bennett, Johan ^{[2
]}

Schotborgh, Carl E. ^{[3
]}

van der Schaaf, Rene ^{[4
]}

Sabate, Manel ^{[5
]}

Moreno, Raul ^{[6
]}

Ameloot, Koen ^{[7
]}

Bommel, Rutger J. van ^{[8
]}

Forlani, Daniele ^{[9
]}

Van Reet, Bert ^{[10
]}

Esposito, Giovanni ^{[11
]}

Dirksen, Maurits T. ^{[12
]}

Ruifrok, Willem P. T. ^{[13
]}

Everaert, Bert R. C. ^{[14
]}

Van Mieghem, Carlos ^{[15
]}

Pinar, Eduardo ^{[16
]}

Alfonso, Fernando ^{[17
]}

Cummins, Paul ^{[1
]}

Lenzen, Mattie ^{[1
]}

Brugaletta, Salvatore ^{[7
]}

Daemen, Joost ^{[1
]}

Boersma, Eric ^{[1
]}

Mieghem, Nicolas M. Van ^{[1
]}

Diletti, Roberto ^{[1
]}

机构：

[1] Erasmus Univ, Dept Cardiol, Thoraxctr, Med Ctr, Rotterdam, Netherlands

[2] Univ Hosp Leuven, Dept Cardiovasc Med, Leuven, Belgium

[3] Haga Hosp, Dept Cardiol, The Hague, Netherlands

[4] Onze Lieve Vrouw Hosp, Dept Cardiol, Amsterdam, Netherlands

[5] Hosp Clin Barcelona, Cardiovasc Inst, Intervent Cardiol Dept, Barcelona, Spain

[6] La Paz Univ Hosp, Cardiol Dept, Intervent Cardiol Unit, Madrid, Spain

[7] Ziekenhuis Oost Limburg, Dept Cardiol, Schiepse Bos, Belgium

[8] Tergooi MC, Dept Cardiol, Hilversum, Netherlands

[9] Santo Spirito Hosp Pescara, Dept Cardiol, Pescara, Italy

[10] AZ Turnhout, Dept Cardiol, Turnhout, Belgium

[11] Univ Naples Federico II, Dept Adv Biomed Sci, Naples, Italy

[12] Noordwest Ziekenhuisgroep, Dept Cardiol, Alkmaar, Netherlands

[13] Treant Zorggroep, Dept Cardiol, Emmen, Netherlands

[14] AZ Monica Hosp, Dept Radiol, Antwerp, Belgium

[15] AZ Groeninge, Dept Cardiol, Kortrijk, Belgium

[16] Virgen Arrixaca Hosp, Dept Cardiol, Intervent Cardiol Unit, Murcia, Spain

[17] Hosp Univ La Princesa Madrid, Ctr Invest Biomed Red Enfermedades Cardiovasc, Dept Cardiol, Madrid, Spain

来源：

JACC-CARDIOVASCULAR INTERVENTIONS | 2024年 / 17卷 / 06期

关键词：

acute coronary syndrome; multivessel disease; percutaneous coronary intervention; revascularization strategy; INVASIVE STRATEGY; NSTEMI PATIENTS; DISEASE; INTERVENTION; METAANALYSIS; EVENTS; SMILE; PCI;

D O I：

10.1016/j.jcin.2024.01.278

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND Complete revascularization of the culprit and all significant nonculprit lesions in patients with non-STsegment elevation acute coronary syndrome (NSTE-ACS) and multivessel disease (MVD) reduces major adverse cardiac events, but optimal timing of revascularization remains unclear. OBJECTIVES This study aims to compare immediate complete revascularization (ICR) and staged complete revascularization (SCR) in patients presenting with NSTE-ACS and MVD. METHODS This prespecified substudy of the BIOVASC (Percutaneous Complete Revascularization Strategies Using Sirolimus Eluting Biodegradable Polymer Coated Stents in Patients Presenting With Acute Coronary Syndrome and Multivessel Disease) trial included patients with NSTE-ACS and MVD. Risk differences of the primary composite outcome of all-cause mortality, myocardial infarction (MI), unplanned ischemia-driven revascularization (UIDR), or cerebrovascular events and its individual components were compared between ICR and SCR at 1 year. RESULTS The BIOVASC trial enrolled 1,525 patients; 917 patients presented with NSTE-ACS, of whom 459 were allocated to ICR and 458 to SCR. Incidences of the primary composite outcome were similar in the 2 groups (7.9% vs 10.1%; risk difference 2.2%; 95% CI:-1.5 to 6.0; P = 0.15). ICR was associated with a significant reduction of MIs (2.0% vs 5.3%; risk difference 3.3%; 95% CI: 0.9 to 5.7; P = 0.006), which was maintained after exclusion of procedure-related MIs occurring during the index or staged procedure (2.0% vs 4.4%; risk difference 2.4%; 95% CI: 0.1 to 4.7; P = 0.032). UIDRs were also reduced in the ICR group (4.2% vs 7.8%; risk difference 3.5%; 95% CI: 0.4 to 6.6; P = 0.018). CONCLUSIONS ICR is safe in patients with NSTE-ACS and MVD and was associated with a reduction in MIs and UIDRs at 1 year. (J Am Coll Cardiol Intv 2024;17:771-782) (c) 2024 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY license (http://creativecommons.org/ licenses/by/4.0/).

引用

页码：771 / 782

页数：12

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