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Staged versus one-step approach for multivessel percutaneous coronary interventions
Eugenia Nikolsky1, Majdi Halabi, Ariel Roguin
1Division of Invasive Cardiology, Rambam Medical Center and the Technion-Israel Institute of Technology, Haifa, Israel.
Insights
Staged percutaneous coronary interventions (PCI) for multivessel coronary artery disease (CAD) appear safe and may reduce long-term cardiac events compared to single-session PCI. This strategy allows for treatment of restenosis.
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.
Background:
Percutaneous coronary interventions (PCIs) in patients with multivessel coronary artery disease (CAD) may be staged or performed in a single session. No data exist about the relative safety and efficacy of these 2 strategies. Our aim was to compare short-term and long-term outcomes of patients with multivessel CAD who underwent PCI in 1 versus 2 sessions.
Methods And Results:
The study included 264 consecutive patients who underwent treatment in our center during 1997 and 1998. PCI was conducted in a single session in 129 patients and was staged in 135 patients. The mean interval between the sessions in the staged group was 45.6 +/- 22.3 days. The rates of major adverse cardiac events (MACEs) during in-hospital stay did not differ significantly between the staged (combined for both stages) and nonstaged groups (2.2% vs 4.6%; P =.28). A trend for 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) favored the staged arm. Diameter stenosis > or =50% was found in 17% of patients in the staged group in the second session and was successfully retreated in most of them. No MACE occurred between the sessions. Multivariate analysis identified staging of the procedure as a single independent predictor of MACE at 1-year follow-up (P =.05).
Conclusion:
Our results suggest that a practical staging strategy within 4 to 8 weeks is safe and allows for identification and treatment of potential excessive proliferative response in the previously intervened lesions during the second procedure.