Multivessel versus IRA-only PCI in patients with NSTEMI and severe left ventricular systolic dysfunction

Area of Science:

• Cardiology
• Interventional Cardiology
• Clinical Research

Background:

• Many patients with non-ST-elevation myocardial infarction (NSTEMI) and multivessel disease (MVD) have severe left ventricular systolic dysfunction (LVSD).
• Optimal percutaneous coronary intervention (PCI) strategy for these high-risk patients remains unclear.
• This study addresses the lack of data on long-term outcomes for different PCI strategies in NSTEMI with MVD and severe LVSD.

Purpose of the Study:

• To compare the long-term outcomes of infarct-related artery (IRA)-only PCI versus multivessel PCI (MV-PCI).
• To evaluate the efficacy of MV-PCI in reducing major adverse cardiovascular events (MACE) in patients with NSTEMI, MVD, and severe LVSD.

Main Methods:

• A retrospective analysis of 228 patients with NSTEMI, MVD, and severe LVSD who underwent successful PCI.
• Patients were divided into IRA-only PCI (n=104) and MV-PCI (n=124) groups.
• Primary outcome was 3-year MACE, including all-cause death, myocardial infarction, stroke, and revascularization. Statistical adjustments included multivariate regression, propensity-score matching, and inverse probability weighting.

Main Results:

• Multivessel PCI was associated with a significantly lower 3-year MACE risk (35.5% vs. 54.8%; p=0.04) compared to IRA-only PCI.
• The reduction in MACE was primarily driven by a significantly lower risk of all-cause death in the MV-PCI group (23.4% vs. 41.4%; p=0.004).
• These findings remained consistent after rigorous statistical adjustments for baseline differences.

Conclusions:

• Multivessel PCI is associated with significantly lower MACE risk in patients with NSTEMI, MVD, and severe LVSD.
• These results offer valuable guidance for clinicians managing this complex patient population.
• The study supports MV-PCI as a potentially superior strategy for improving long-term outcomes in these high-risk individuals.