Meta-analysis Comparing Multivessel Versus Culprit Coronary Arterial Revascularization for Patients With
Vincent R Siebert1, Sanket Borgaonkar2, Xiaoming Jia2
1Department of Medicine, Baylor College of Medicine, Houston, Texas.
Insights
Multivessel revascularization (MVR) in non-ST-segment-elevation acute coronary syndrome (NSTE-ACS) shows higher short-term risks but offers significant long-term benefits, including reduced major adverse cardiac events and death.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Research
Background:
- Non-ST-segment-elevation acute coronary syndrome (NSTE-ACS) is the most prevalent form of acute coronary syndrome.
- Multivessel disease is frequently observed in NSTE-ACS patients.
- Optimal single-procedure revascularization strategy for NSTE-ACS patients undergoing percutaneous coronary intervention without meeting coronary artery bypass grafting criteria remains debated.
Purpose of the Study:
- To systematically review and compare the efficacy and safety of single-procedure multivessel revascularization (MVR) versus culprit vessel only revascularization in NSTE-ACS patients.
- To evaluate short-term and long-term outcomes, including major adverse cardiac events, stroke, urgent coronary artery bypass grafting, all-cause death, and repeat revascularization.
Main Methods:
- Systematic review and meta-analysis of 15 studies identified from PubMed and EMBASE.
- Random effects model used to calculate odds ratios (OR) with 95% confidence intervals (CI).
- Cochrane's Q and Higgins I2 tests employed to assess heterogeneity.
Main Results:
- Short-term: MVR group showed higher rates of major adverse cardiac events (OR 1.14) and stroke (OR 1.94), but lower rates of urgent/emergent coronary artery bypass grafting (OR 0.35).
- Long-term: MVR group demonstrated reduced major adverse cardiac events (OR 0.76), all-cause death (OR 0.83), and repeat revascularization (OR 0.62).
- Baseline characteristics between groups were similar.
Conclusions:
- Single-procedure multivessel revascularization (MVR) in NSTE-ACS is associated with increased short-term risks but confers significant long-term clinical benefits.
- These findings support the consideration of MVR for suitable NSTE-ACS patients undergoing percutaneous coronary intervention.
- Long-term advantages include decreased mortality and need for repeat procedures.
Abstract:
We present a systematic review and meta-analysis comparing efficacy and safety outcomes between single procedure multivessel revascularization (MVR) and culprit vessel only revascularization in patients presenting with non-ST-segment-elevation acute coronary syndrome (NSTE-ACS). NSTE-ACS is the most common form of acute coronary syndrome (ACS), and multivessel disease is common. There is no consensus on the most efficacious single procedure revascularization strategy for patients undergoing percutaneous coronary intervention not meeting coronary artery bypass grafting criteria. Studies in PubMed and EMBASE databases were systematically reviewed, and 15 studies met criteria for inclusion in the meta-analysis. Baseline characteristics between the groups were similar. A random effects model was used to calculate odds ratios (OR) with 95% confidence intervals (CI). Heterogeneity of studies was assessed using Cochrane's Q and Higgins I2 tests. For short-term outcomes, patients who underwent MVR had higher rates of major adverse cardiac events (OR 1.14; 95% CI 1.01 to 1.29; p = 0.03); and stroke (OR 1.94; 95% CI 1.01 to 3.72; p = 0.05), but lower rates of urgent or emergent coronary artery bypass grafting (OR 0.35; 95% CI 0.29 to 0.43; p <0.00001). In the long-term, MVR patients had less frequent major adverse cardiac events (OR 0.76; 95% CI 0.61-0.93; p = 0.009), all-cause death (OR 0.83; 95% CI 0.71 to 0.97; p = 0.03), and repeat revascularization, (OR 0.62; 95% CI 0.42 to 0.90; p = 0.01). MVR following NSTE-ACS was associated with higher short-term risk, but long-term benefit. In conclusion, these results support the use of single procedure multivessel revascularization for NSTE-ACS patients who are suitable candidates at the time of percutaneous coronary intervention.
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