Ten-Year Outcomes Following Revascularization Strategies for Non-ST-Segment Elevation Myocardial Infarction and...

Area of Science:

• Cardiology
• Interventional Cardiology
• Clinical Outcomes Research

Background:

• Conflicting guidelines exist for revascularization in non-ST-segment elevation myocardial infarction (NSTEMI) with multivessel disease (MVD).
• Optimal timing and strategy for revascularization remain debated.
• Understanding long-term outcomes is crucial for patient management.

Purpose of the Study:

• To compare long-term outcomes of immediate complete revascularization (ICR), staged complete revascularization (SCR), and non-complete revascularization (NCR) in NSTEMI patients with MVD.
• To evaluate the impact of timing within SCR on outcomes.
• To inform evidence-based treatment strategies.

Main Methods:

• Retrospective analysis of 316 NSTEMI patients with MVD.
• Categorization into ICR, SCR (≤24 hours and >24 hours), and NCR groups.
• Assessment of cardiac composite outcomes (cardiac death, recurrent MI) during follow-up.

Main Results:

• SCR demonstrated significantly lower risk compared to ICR (HR 0.27, P=0.001).
• No significant difference was observed between NCR and SCR (HR 1.06, P=0.832).
• Staged revascularization within 24 hours (SCR1) showed significantly lower adverse events than SCR >24 hours (16.7% vs. 47.1%, P=0.038).

Conclusions:

• Immediate complete revascularization (ICR) and staged complete revascularization (SCR) within 24 hours are associated with favorable long-term outcomes.
• Timely SCR (≤24 hours) is superior to delayed SCR (>24 hours) for NSTEMI patients with MVD.
• These findings support prompt revascularization strategies for improved patient prognosis.