Single-session versus staged procedures for elective multivessel percutaneous coronary intervention.

The treatment of patients with multivessel coronary artery disease remains a clinical challenge. Established knowledge shows that both single-session and staged percutaneous coronary intervention (PCI) are used to manage such cases. However, the long-term comparative effectiveness of these strategies is not fully understood. Prior research has shown that procedural approaches vary widely across institutions and patient populations. No prior work had resolved whether one strategy leads to better clinical outcomes than the other. This uncertainty drove the need for a large registry-based study to evaluate the impact of these two approaches. The lack of clarity in the literature highlights a critical gap in evidence-based decision-making for clinicians. Understanding the relative risks and benefits of each strategy is essential for optimizing patient care. This paper contributes by analyzing a large cohort of patients to assess long-term outcomes.

This study aimed to evaluate the clinical outcomes of single-session versus staged multivessel PCI in patients with stable coronary artery disease or non-ST-elevation acute coronary syndrome. The researchers sought to determine whether one strategy leads to better 5-year outcomes than the other. They focused on patients who underwent elective multivessel PCI, a common but complex intervention. The motivation for the study was to provide evidence for clinical decision-making in this area. No prior study had directly compared these two strategies in a large registry. The researchers used a well-defined primary outcome measure to assess effectiveness. They also considered the 30-day outcomes to evaluate short-term risks. This study contributes to the ongoing debate about optimal PCI strategies for multivessel disease.

The researchers analyzed data from the Coronary REvascularisation Demonstrating Outcome Study in Kyoto PCI/coronary artery bypass grafting registry cohort-2. They included 2018 patients who underwent elective multivessel PCI. The study compared two procedural strategies: single-session and staged multivessel PCI. Patients were divided into two groups based on the approach used. The primary outcome was a composite of all-cause death, myocardial infarction, and stroke at 5 years. The researchers also evaluated 30-day outcomes to assess short-term risks. Subgroup analyses were conducted to explore interactions with factors like age, gender, and comorbidities. The study used registry data to ensure real-world applicability of the findings.

The 5-year incidence of the primary outcome was 26.7% in the single-session group and 23.0% in the staged group. The adjusted risk for the primary outcome was not significantly different between the two groups. The hazard ratio was 0.91 with a 95% confidence interval of 0.72 to 1.16. These findings suggest no significant long-term benefit of one strategy over the other. The 30-day all-cause death rate was higher in the single-session group (1.1% vs 0.2%). However, the causes of death were not related to procedural complications. Subgroup analyses showed no significant interactions between patient characteristics and the effect of the strategies. The single-session approach was used in 35% of patients, indicating its limited adoption.

The study found that single-session multivessel PCI was associated with at least comparable 5-year clinical outcomes compared to the staged approach. The authors did not observe a significant difference in the primary outcome between the two strategies. The higher 30-day mortality in the single-session group was not due to procedural complications. The researchers proposed that the single-session strategy may be a viable option in selected patients. Their findings suggest that both strategies are acceptable from a long-term outcome perspective. The authors did not claim that one strategy is superior to the other. They emphasized the need for further research to clarify the role of single-session PCI. Their results support the continued use of both strategies based on clinical judgment.