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A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
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Complete Revascularization (CR) Versus Culprit-Only Percutaneous Coronary Intervention (CO-PCI) in NSTE-ACS with

Kesar Prajapati1, Shanmukh Sai Pavan Lingamsetty2, Harshith Thyagaturu3

  • 1Internal Medicine, Metropolitan Hospital Center, NYC Health + Hospital, New York, New York, USA.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|April 28, 2025
PubMed

Insights

Complete revascularization (CR) significantly reduces mortality and reinfarction in Non-ST-Elevation Acute Coronary Syndrome (NSTE-ACS) patients with multivessel disease. This strategy is superior to culprit vessel only-Percutaneous Coronary Intervention (CO-PCI).

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Clinical Trials

Background:

  • Complete revascularization (CR) is proven effective in ST-Elevation Myocardial Infarction (STEMI).
  • The benefit of CR versus culprit vessel only-Percutaneous Coronary Intervention (CO-PCI) in Non-ST-Elevation Acute Coronary Syndrome (NSTE-ACS) with multivessel disease is not well-established.
  • This meta-analysis addresses the optimal revascularization strategy in NSTE-ACS.

Purpose of the Study:

  • To compare the efficacy of CR versus CO-PCI in NSTE-ACS patients with multivessel disease.
  • To evaluate the impact of CR on mortality, myocardial reinfarction, and other adverse cardiovascular events.

Main Methods:

  • A systematic literature search was conducted across PubMed, Embase, and Cochrane databases.
  • Eleven studies involving 36,997 NSTE-ACS patients were included.
  • A random-effects model was used for meta-analysis, calculating risk ratios (RR) and 95% confidence intervals (CI).

Main Results:

  • CR significantly reduced all-cause mortality (RR: 0.66; 95% CI: 0.55 to 0.79).
  • Myocardial reinfarction rates were lower with CR (RR: 0.57; 95% CI: 0.43 to 0.76).
  • CR also led to a reduction in composite endpoints (RR: 0.72; 95% CI: 0.63 to 0.82) and repeat revascularization (RR: 0.60; 95% CI: 0.54 to 0.66).

Conclusions:

  • Complete revascularization is associated with improved outcomes in NSTE-ACS patients with multivessel disease.
  • CR demonstrates a significant reduction in all-cause mortality, recurrent myocardial infarction, composite outcomes, and the need for repeat revascularization compared to CO-PCI.
  • These findings support CR as the preferred strategy in this patient population.
Abstract

Keywords:
NSTE‐ACS (Non‐ST‐Elevation Acute Coronary Syndrome)culprit‐only PCImultivessel PCImultivessel disease (MVD)

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