Single-vessel or multivessel PCI in patients with multivessel disease presenting with non-ST-elevation acute coronary
Yoshinobu Onuma1, Takashi Muramatsu, Chrysafios Girasis
1Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
Insights
Multivessel PCI significantly lowers all-cause mortality in non-ST-segment acute coronary syndromes (NSTE-ACS) patients compared to single-vessel PCI. This intervention strategy may improve long-term survival for NSTE-ACS patients with multivessel coronary disease.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Research
Background:
- Coronary artery disease often presents as diffuse, affecting multiple vessels.
- Patients with non-ST-segment acute coronary syndromes (NSTE-ACS) frequently have multivessel coronary disease.
- Optimal treatment strategies for NSTE-ACS patients with multivessel disease require clarification.
Purpose of the Study:
- To evaluate the impact of interventions on non-culprit lesions in NSTE-ACS patients.
- To determine if multivessel PCI (MVPCI) reduces future adverse events compared to single-vessel PCI (SVPCI).
Main Methods:
- Retrospective cohort study of 990 NSTE-ACS patients undergoing SVPCI or MVPCI.
- Cox proportional hazards regression and propensity matching were used to control for confounding factors.
- Propensity-matched cohorts (n=230 each) were analyzed for outcomes.
Main Results:
- MVPCI patients had fewer prior interventions and more complex lesions than SVPCI patients.
- At three years, MVPCI was associated with significantly lower all-cause mortality (13.0% vs. 18.3%, p=0.02).
- In propensity-matched analysis, MVPCI remained associated with significantly lower all-cause death (adjusted HR 0.41).
Conclusions:
- Multivessel PCI significantly reduces all-cause mortality in NSTE-ACS patients compared to single-vessel PCI.
- These findings suggest a potential survival benefit for MVPCI in this patient population.
- Further research is needed to confirm these outcomes.
Aims:
Coronary artery disease is often diffuse and patients with non-ST-segment acute coronary syndromes (NSTE-ACS) demonstrate multivessel coronary disease. The purpose of this study was to clarify whether interventions on stable chronic non-culprit lesions in patients with NSTE-ACS can prevent future adverse events.
Methods And Results:
We performed a retrospective cohort study of 990 consecutive patients who underwent either single-vessel PCI (SVPCI: n=379) or multivessel PCI (MVPCI: n=611) in a setting of NSTE-ACS. Cox proportional hazards regression analysis was performed to compensate for differences in baseline characteristics between the groups. To minimise the impact of confounding factors, we performed propensity matching (SVPCI: n=230, MVPCI: n=230). Patients who had MVPCI had a lower rate of prior interventional treatment or myocardial infarction, and more complex lesions than patients with SVPCI. At three years, all-cause mortality was significantly lower in the MVPCI group than the SVPCI group (13.0% vs. 18.3%, p=0.02, adjusted HR 0.55, 95% CI: 0.38-0.80), while the rates of target vessel revascularisation and a composite of all-cause death or myocardial infarction were not different between the groups. In the propensity-matched cohort, all-cause death remained significantly lower in the MVPCI group (adjusted HR 0.41, 95% CI: 0.22-0.75) compared to the SVPCI group.
Conclusions:
In this retrospective study, multivessel PCI reduced all-cause mortality in a setting of NSTE-ACS compared to single-vessel PCI. Further investigations to confirm these results are warranted.
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