Staged versus one-step approach for multivessel percutaneous coronary interventions.

Area of Science:

• Cardiology
• Interventional Cardiology

Background:

• Multivessel coronary artery disease (CAD) requires percutaneous coronary interventions (PCI).
• PCI can be performed in one session or staged over multiple sessions.
• Limited data exist on the comparative safety and efficacy of single-session versus staged PCI for multivessel CAD.

Purpose of the Study:

• To compare short-term and long-term outcomes of staged versus single-session PCI in patients with multivessel CAD.
• To evaluate the safety and efficacy of a staged PCI approach.

Main Methods:

• A retrospective study of 264 patients with multivessel CAD undergoing PCI between 1997 and 1998.
• Patients were divided into single-session (129 patients) and staged (135 patients) PCI groups.
• Follow-up included in-hospital, 30-day, and 1-year assessments for major adverse cardiac events (MACE).

Main Results:

• In-hospital MACE rates were similar: 2.2% in staged vs. 4.6% in single-session (P=.28).
• A trend favored staged PCI with lower event rates at 30-day (2.9% vs. 6.9%; P=.13) and 1-year follow-up (26.1% vs. 35.9%; P=.08).
• Staging was an independent predictor of reduced MACE at 1-year (P=.05); 17% of staged patients required retreatment for restenosis in the second session.

Conclusions:

• A staged PCI strategy, particularly within 4 to 8 weeks, is safe for multivessel CAD.
• Staging allows for identification and treatment of excessive proliferative response in previously intervened lesions.
• This approach may improve long-term outcomes in select patients.