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Impact of Immediate Versus Staged Complete Revascularization on Short-Term and Long-Term Clinical Outcomes in
Qiufeng Jia1,2,3, Ankai Zuo4, Chengrui Zhang1,2,3
1State Key Laboratory for Innovation and Transformation of Luobing Theory, Jinan, China.
Insights
Immediate complete revascularization (ICR) in acute coronary syndrome (ACS) with multivessel disease (MVD) reduces revascularization and re-infarction risks. However, ICR may increase short-term all-cause mortality compared to staged complete revascularization (SCR).
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Trials
Background:
- Complete revascularization (CR) in acute coronary syndrome (ACS) with multivessel disease (MVD) improves patient prognosis.
- This meta-analysis compares immediate complete revascularization (ICR) with staged complete revascularization (SCR) in ACS patients with MVD.
Purpose of the Study:
- To evaluate the short-term and long-term clinical outcomes of ICR versus SCR in ACS patients with MVD.
- To determine the efficacy and safety of different revascularization strategies.
Main Methods:
- Systematic search of online databases for relevant randomized controlled trials (RCTs).
- Inclusion of eight RCTs involving 5198 patients.
- Analysis of primary outcomes including long-term and short-term revascularization, re-infarction, cardiovascular death or myocardial infarction, all-cause death, stroke, and heart failure hospitalizations. Safety endpoints included stent thrombosis and major bleeding.
Main Results:
- ICR significantly reduced long-term unplanned ischemia-driven revascularization, re-infarction, and the composite outcome of cardiovascular death or myocardial infarction compared to SCR.
- ICR also decreased short-term unplanned ischemia-driven revascularization and re-infarction.
- A statistically significant increase in 1-month all-cause death was observed in the ICR group compared to SCR.
Conclusions:
- ICR demonstrates a significant benefit in reducing both short-term and long-term unplanned revascularization and re-infarction in ACS patients with MVD.
- ICR also improves the long-term composite outcome of cardiovascular death or myocardial infarction.
- A potential increased risk of 1-month all-cause mortality warrants consideration when choosing between ICR and SCR.
Background:
In patients with acute coronary syndrome (ACS) and multivessel disease (MVD), complete revascularization (CR) improves prognosis. This meta-analysis, summarizing recent RCTs, contrasts short-term and long-term clinical outcomes between immediate complete revascularization (ICR) and staged complete revascularization (SCR).
Methods:
We systematically searched the online database and eight RCTs were involved. The primary outcomes included long-term unplanned ischemia-driven revascularization, re-infarction, combined cardiovascular (CV) death or myocardial infarction (MI), all-cause death, CV death, stroke, and hospitalization for heart failure (HHF). The secondary outcomes were 1-month unplanned ischemia-driven revascularization, re-infarction, all-cause death, and CV death. Safety endpoints included stent thrombosis and major bleeding.
Results:
Eight RCTs comprising 5198 patients were involved. ICR reduced long-term unplanned ischemia-driven revascularization (RR 0.64, 95% CI 0.51-0.81, p < 0.001), combined CV death or MI (HR 0.51, 95% CI 0.34-0.78, p = 0.002), and re-infarction (RR 0.66,95% CI 0.48 to 0.91, p = 0.012) compared with SCR. ICR also decreased 1-month unplanned ischemia-driven revascularization (RR 0.41, 95% CI: 0.21-0.77, p = 0.006) and re-infarction (RR 0.33, 95% CI:0.15-0.74, p = 0.007) but increased 1-month all-cause death (RR 2.22, 95% CI 1.06-4.65, p = 0.034).
Conclusion:
In ACS patients with MVD, we first found that ICR significantly lowered the risk of both short-term and long-term unplanned ischemia-driven revascularization and re-infarction, as well as the long-term composite outcome of CV death or MI compared with SCR. However, there may be an increase in 1-month all-cause death in the ICR group.
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