Timing of Complete Multivessel Revascularization in Patients Presenting With Non-ST-Segment Elevation Acute Coronary...

Area of Science:

• Cardiology
• Interventional Cardiology
• Acute Coronary Syndromes

Background:

• Complete revascularization in NSTE-ACS with MVD reduces adverse cardiac events.
• Optimal timing for complete revascularization in NSTE-ACS and MVD is not well-defined.

Purpose of the Study:

• To compare immediate complete revascularization (ICR) versus staged complete revascularization (SCR) in patients with NSTE-ACS and MVD.
• To evaluate the safety and efficacy of ICR versus SCR regarding major adverse cardiac events at one year.

Main Methods:

• A substudy of the BIOVASC trial involving patients with NSTE-ACS and MVD.
• Comparison of primary composite outcome (all-cause mortality, MI, UIDR, cerebrovascular events) and individual components between ICR and SCR groups at 1-year follow-up.

Main Results:

• No significant difference in the primary composite outcome between ICR and SCR (7.9% vs 10.1%, P=0.15).
• ICR significantly reduced myocardial infarctions (MIs) compared to SCR (2.0% vs 5.3%, P=0.006), including procedure-related MIs.
• ICR also led to a significant reduction in unplanned ischemia-driven revascularizations (UIDRs) (4.2% vs 7.8%, P=0.018).

Conclusions:

• Immediate complete revascularization (ICR) is a safe strategy for patients with NSTE-ACS and MVD.
• ICR demonstrated a significant reduction in MIs and UIDRs at one year compared to SCR.