Long-Term Outcomes of Complete Revascularization With Percutaneous Coronary Intervention in Acute Coronary Syndromes
Kevin R Bainey1, Wendimagegn Alemayehu2, Paul W Armstrong3
1Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada; Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada.
Insights
Complete revascularization in patients with acute coronary syndromes (ACS) and multivessel disease undergoing percutaneous coronary intervention (PCI) is common. It significantly reduces major adverse cardiovascular events and death within five years.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- Controversy exists regarding the optimal revascularization strategy for patients with acute coronary syndromes (ACS) and multivessel disease.
- Percutaneous coronary intervention (PCI) is a common treatment, but its benefit in multivessel disease within ACS is debated.
Purpose of the Study:
- To evaluate the long-term clinical outcomes of patients with ACS and multivessel disease who underwent PCI.
- To compare outcomes between complete and incomplete revascularization strategies in this patient population.
Main Methods:
- A retrospective analysis of 9,094 patients with ACS and multivessel disease from the Alberta COAPT registry (2007-2013).
- Patients were categorized based on complete (residual jeopardy score ≤10%) versus incomplete multivessel PCI.
- Outcomes assessed included a composite of all-cause death or new myocardial infarction, and a composite of death, MI, or repeat revascularization.
Main Results:
- Complete revascularization was performed in 66.0% of patients.
- Complete revascularization was associated with a significantly lower rate of the primary composite endpoint (15.4% vs. 22.2% at 5 years; IPW-HR: 0.78).
- Complete revascularization also reduced the secondary composite endpoint (23.3% vs. 37.5% at 5 years; IPW-HR: 0.61) and individual components like death, MI, and repeat revascularization.
Conclusions:
- Complete revascularization in patients with ACS and multivessel disease undergoing PCI is frequently achieved.
- This strategy is associated with improved clinical outcomes, including reduced mortality and myocardial infarction, within a 5-year follow-up period.
Objectives:
The aim of this study was to evaluate the long-term outcomes of patients with acute coronary syndromes (ACS) with multivessel disease undergoing percutaneous coronary intervention (PCI).
Background:
Controversy exists regarding the benefit of multivessel PCI across the spectrum of ACS.
Methods:
A total of 9,094 patients with ACS and multivessel disease (≥70% stenosis in 2 or more major epicardial vessels) undergoing PCI from the Alberta COAPT (Contemporary Acute Coronary Syndrome Patients Invasive Treatment Strategies) registry (April 1, 2007, to March 31, 2013) were reviewed. Comparisons were made between patients who underwent complete revascularization and those with incomplete revascularization. Complete revascularization was defined as multivessel PCI with a residual angiographic jeopardy score ≤10%. Associations between revascularization status and all-cause death or new myocardial infarction (primary composite endpoint) and all-cause death, new myocardial infarction, or repeat revascularization (secondary composite endpoint) were evaluated.
Results:
Of the study cohort, 66.0% underwent complete revascularization. Compared with incomplete revascularization, the primary composite endpoint occurred less frequently with complete revascularization (event rate within 5 years 15.4% vs. 22.2%; inverse probability-weighted hazard ratio [IPW-HR]: 0.78; 95% confidence interval [CI]: 0.73 to 0.84; p < 0.0001). The secondary composite endpoint was less likely to occur with complete revascularization (event rate within 5 years 23.3% vs. 37.5%; IPW-HR: 0.61; 95% CI: 0.58 to 0.65; p < 0.0001). Complete revascularization was associated with a reduction in all-cause death (IPW-HR: 0.79; 95% CI: 0.73 to 0.86; p = 0.0004), new myocardial infarction (IPW-HR: 0.76; 95% CI: 0.69 to 0.84; p < 0.0001), and repeat revascularization (IPW-HR: 0.53; 95% CI: 0.49 to 0.57; p < 0.0001).
Conclusions:
Results from this large contemporary registry of patients with ACS and PCI for multivessel disease suggest that complete revascularization occurs commonly and is associated with improved clinical outcomes (including survival) within 5 years.
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