Staged versus one-time complete revascularization with percutaneous coronary intervention for multivessel coronary
Edward L Hannan1, Zaza Samadashvili, Gary Walford
1University at Albany, State University of New York, Albany, NY 12144-3456, USA. elh03@health.state.ny.us
Insights
For patients with coronary artery disease without ST-elevation myocardial infarction (STEMI), complete revascularization (CR) during the initial admission versus staging for CR in a subsequent admission showed no significant difference in 3-year mortality rates. This finding applies to both acute coronary syndrome and non-acute coronary syndrome patient groups.
Area of Science:
- Cardiology
- Interventional Cardiology
- Health Outcomes Research
Background:
- Evidence-based guidelines exist for ST-elevation myocardial infarction (STEMI) management with percutaneous coronary intervention (PCI).
- Comparative data on complete revascularization (CR) strategies in patients with coronary artery disease (CAD) but without STEMI is lacking.
- This study addresses the optimal timing of PCI for CR in non-STEMI CAD patients.
Purpose of the Study:
- To compare the 3-year mortality rates of CR performed during the index admission versus staged CR within 60 days for patients with CAD but without STEMI.
- To evaluate outcomes in patients with and without acute coronary syndrome (ACS) but without STEMI.
Main Methods:
- Retrospective analysis of PCI patients without STEMI from New York (2007-2009).
- Patients were categorized into ACS without STEMI and no ACS groups.
- Propensity-matched analysis compared in-index CR versus staged CR (within 60 days) based on 17 mortality risk factors.
- Three-year all-cause mortality was the primary outcome.
Main Results:
- For patients without ACS (but without STEMI), 3-year mortality was 5.62% for in-index CR vs. 5.97% for staged CR (P=0.93).
- For patients with ACS but without STEMI, 3-year mortality was 6.59% for in-index CR vs. 5.92% for staged CR (P=0.41).
- No statistically significant difference in mortality was observed between the two CR strategies in either subgroup.
Conclusions:
- Staged PCI for complete revascularization in patients with coronary artery disease without STEMI does not lead to significantly higher 3-year mortality compared to complete revascularization during the index admission.
- The timing of complete revascularization in non-STEMI CAD patients does not appear to impact long-term mortality.
- These findings suggest flexibility in planning PCI strategies for non-STEMI CAD patients.
Background:
There are evidence-based guidelines for staging of patients with ST-elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI), but we are not aware of any evidence comparing the strategy of complete revascularization (CR) with PCI in the index admission versus the strategy of staging in a subsequent admission for patients with coronary artery disease without STEMI.
Methods And Results:
PCI patients without STEMI undergoing PCI in New York between 2007 and 2009 were separated into 2 groups: those with acute coronary syndrome but no STEMI, and those without acute coronary syndrome. For each group, patients who underwent CR in the index admission were then propensity matched to patients staged within 60 days to obtain CR based on 17 patient risk factors related to longer-term mortality, and 3-year mortality rates were compared for the propensity-matched groups. Outcomes were also compared for preselected subgroups. For propensity-matched patients without acute coronary syndrome, the all-cause mortality rates at 3 years for patients who underwent CR in the index hospitalization and patients staged for CR within 60 days of discharge were 5.62% and 5.97%, P=0.93, respectively. For propensity-matched patients with acute coronary syndrome but without STEMI, the all-cause mortality rates at 3 years for patients who underwent CR in the index hospitalization and patients staged for CR within 60 days of discharge were 6.59% and 5.92%, P=0.41, respectively.
Conclusions:
Patients with coronary artery disease without STEMI do not have significantly lower 3-year mortality rates with staged PCI than when they undergo CR in the index admission.
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