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Complete Revascularization in NSTE-ACS and Multivessel Disease: Clinical Outcomes and Prognostic Implications

Silviu Raul Muste1, Cristiana Bustea1,2, Elena Emilia Babes1,3

  • 1Doctoral School of Biomedical Sciences, Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania.

Life (Basel, Switzerland)
|August 28, 2025
PubMed

Insights

Complete revascularization significantly reduces mortality and ischemic events in non-ST-segment-elevation acute coronary syndrome patients with multivessel coronary artery disease. This strategy is superior to incomplete revascularization for better patient outcomes.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Acute Coronary Syndromes

Background:

  • Non-ST-segment-elevation acute coronary syndrome (NSTE-ACS) frequently co-occurs with multivessel coronary artery disease (MVD).
  • Treatment decisions are complex, with current guidelines recommending complete revascularization (CR), but lacking robust evidence in hemodynamically stable patients.
  • The comparative benefit of CR versus incomplete revascularization (IR) for reducing ischemic events and improving cardiac function in NSTE-ACS with MVD is not well-established.

Purpose of the Study:

  • To evaluate the impact of CR versus IR on major adverse cardiac and cerebrovascular events in hemodynamically stable NSTE-ACS patients with MVD.
  • To assess the effect of CR on all-cause mortality, cardiac death, and ischemic readmissions at 6 and 12 months.
  • To determine the influence of CR on left ventricular ejection fraction (LVEF) improvement and hospital length of stay.

Main Methods:

  • A retrospective study included 282 hemodynamically stable NSTE-ACS patients with MVD.
  • Patients were divided into two groups: complete revascularization (CR, n=218) and incomplete revascularization (IR, n=64).
  • Outcomes assessed included a composite of all-cause mortality, cardiac death, and ischemic readmissions at 6 and 12 months, LVEF, and hospital stay.

Main Results:

  • The 6-month composite outcome occurred in 11.0% of CR patients versus 40.6% of IR patients (p < 0.001).
  • The 12-month composite outcome occurred in 22.0% of CR patients versus 68.8% of IR patients (p < 0.001).
  • CR was associated with significantly lower rates of death, myocardial infarction, and unstable angina; stroke incidence was similar. CR and baseline LVEF were independent predictors of 12-month outcomes.

Conclusions:

  • Complete revascularization is a preferred therapeutic strategy for hemodynamically stable NSTE-ACS patients with MVD.
  • CR significantly improves event-free survival and reduces mortality and ischemic events compared to IR.
  • Prospective randomized studies are warranted to confirm these findings.

Keywords:
NSTE-ACSSTEMIacute coronary syndromecomplete revascularizationleft ventricular ejection fractionmultivessel coronary disease

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