"One-Time" versus Staged Multivessel Intervention in Intermediate to Very High-Risk Patients with Non-ST-Segment
Xiaofan Yu1, Yi Li2, Qiancheng Wang3
1Department of Cardiology, The Second Hospital of Dalian Medical University, Dalian, Liao Ning, China.; Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, Liao Ning, China.; Department of Cardiology, Anhui Provincial Hospital, Hefei, Anhui, China.
Insights
For high-risk patients with non-ST-segment elevation acute coronary syndromes and multivessel disease, staged percutaneous coronary intervention (PCI) showed a significant reduction in cardiac death or myocardial infarction compared to one-time PCI, particularly within the first 90 days.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes Research
Background:
- Multivessel coronary disease (MVD) in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) presents complex treatment decisions.
- Risk stratification is crucial for determining optimal percutaneous coronary intervention (PCI) strategies in intermediate to very high-risk patients.
Purpose of the Study:
- To compare the 3-year clinical outcomes of staged versus one-time PCI in high-risk NSTE-ACS patients with MVD.
- To evaluate the safety and efficacy of different PCI timing strategies in this patient population.
Main Methods:
- A cohort of 1531 intermediate to very high-risk NSTE-ACS patients with MVD undergoing PCI was analyzed from a prospectively registered database (2008-2012).
- Patients were divided into "one-time" PCI (n=859) and staged PCI (n=672) groups.
- Primary outcomes included 3-year major adverse cardiac events (MACE), cardiac death, myocardial infarction (MI), and target vessel revascularization, with propensity score matching and landmark analyses performed.
Main Results:
- After propensity score matching, staged PCI demonstrated a significantly lower incidence of cardiac death/MI (7.0% vs. 11.1%, p=0.033) compared to one-time PCI at 3 years.
- A significantly lower 90-day incidence of MACE (1.2% vs. 3.3%, p=0.037) and cardiac death/MI (0.7% vs. 2.6%, p=0.031) was observed in the staged PCI group.
- No significant differences in overall 3-year MACE were found between the groups (18.9% vs. 21.8%, p=0.249) after matching.
Conclusions:
- Staged PCI is superior to one-time PCI in reducing cardiac death and myocardial infarction in intermediate to very high-risk NSTE-ACS patients with MVD.
- The benefit of staged PCI appears most pronounced in the early post-procedural period (within 90 days).
Background And Objectives:
To compare clinical outcomes of staged versus "one-time" percutaneous coronary intervention (PCI) in intermediate to very high-risk patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) and multivessel coronary disease (MVD).
Subjects And Methods:
1531 NSTE-ACS patients with multivessel PCI and meeting the criteria of intermediate to very high risk were screened from a prospectively registered database obtained from General Hospital of Shenyang Military Region between 2008 and 2012. They were categorized into "one-time" PCI (n=859) and staged PCI (n=672) according to intervention strategy. The primary outcomes included a 3-year major adverse cardiac event (MACE), a composite of cardiac death, myocardial infarction (MI), and target vessel revascularization.
Results:
At 3 years, no significant differences in MACE (20.8% vs. 19.7%, p=0.608) and cardiac death/MI (7.1% vs. 9.1%, p=0.129) were observed between the two groups. After propensity score matching, there was no statistical significance in MACE (18.9% vs. 21.8%, p=0.249); whereas cardiac death/MI was significantly lower in the staged PCI group (7.0% vs.11.1%, p=0.033). Ninety-day landmark analysis showed that the staged PCI group had a lower 90-day incidence of MACE (1.2% vs. 3.3%, p= 0.037) and cardiac death/MI (0.7% vs. 2.6%, p=0.031). For the 90-day to 3-year follow-up period, the incidences of MACE (17.9% vs. 19.1%, p=0.641) and cardiac death/MI (6.3% vs. 8.7%, p=0.191) were similar in both groups.
Conclusion:
In intermediate- to very high-risk NSTE-ACS patients with MVD, staged PCI is superior to "one-time" PCI in terms of cardiac death/MI.
Related Concept Videos
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:30Acute Coronary Syndrome I: Introduction
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:27Coronary Artery Disease V: Interprofessional Care
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:26Angina IV: Management