Comparison of Clinical Outcomes Between Incomplete and Complete Revascularization in NSTEMI Patients With Multivessel...

Area of Science:

• Cardiology
• Interventional Cardiology
• Clinical Outcomes Research

Background:

• The optimal revascularization strategy for non-ST-segment elevation myocardial infarction (NSTEMI) with multivessel disease is debated.
• Percutaneous coronary intervention (PCI) is a common treatment, but the extent of revascularization requires clarification.

Purpose of the Study:

• To compare 3-year clinical outcomes between complete revascularization (CR) and incomplete revascularization (IR) in NSTEMI patients with multivessel disease.
• To evaluate the impact of CR versus IR on major adverse cardiac events (MACE).

Main Methods:

• Analysis of 6,987 NSTEMI patients with multivessel disease from the KAMIR-NIH and KAMIR-V registries who underwent PCI.
• CR defined as residual stenosis <30% in all major vessels (≥2.25 mm) with TIMI flow grade 3.
• Primary endpoint: 3-year MACE (all-cause death, recurrent MI, unplanned repeat revascularization, heart failure hospitalization).

Main Results:

• CR (3,072 patients) was associated with significantly lower 3-year MACE compared to IR (3,915 patients) (18.6% vs 26.9%; adjusted HR: 0.75).
• CR reduced cardiac death/recurrent MI (adjusted HR: 0.76) and unplanned repeat revascularization (adjusted HR: 0.68).
• Results remained consistent after propensity score matching and inverse probability weighting.

Conclusions:

• Complete revascularization in NSTEMI patients with multivessel disease leads to significantly better 3-year clinical outcomes than incomplete revascularization.
• CR is associated with reduced risks of major adverse cardiac events, including death, myocardial infarction, and repeat procedures.