Complete Revascularization Versus Culprit-Only Percutaneous Coronary Intervention in Non-ST-Elevation Myocardial...

Area of Science:

• Cardiology
• Interventional Cardiology
• Health Services Research

Background:

• Multivessel coronary artery disease (CAD) in non-ST-elevation myocardial infarction (NSTEMI) presents treatment challenges.
• Percutaneous coronary intervention (PCI) strategies include culprit-only versus complete revascularization.
• Optimal PCI strategy for NSTEMI with multivessel CAD remains debated.

Purpose of the Study:

• To compare the outcomes of complete revascularization versus culprit-only PCI in hospitalized adults with NSTEMI and multivessel CAD.
• To evaluate in-hospital major bleeding, mortality, and major adverse cardiovascular events (MACE).

Main Methods:

• Retrospective analysis of the National Inpatient Sample (2016-2022).
• Inclusion of adult NSTEMI hospitalizations with multivessel CAD, excluding complex cases.
• 1:1 propensity score matching on 52 covariates for 37,048 pairs.

Main Results:

• Complete revascularization was associated with significantly higher in-hospital major bleeding (12.22% vs 10.52%; OR 1.18).
• In-hospital mortality was similar between groups (1.01% vs 0.98%).
• Major adverse cardiovascular events trended lower with complete revascularization, driven by reduced recurrent myocardial infarction, but resulted in longer hospital stays and higher costs.

Conclusions:

• Complete revascularization in NSTEMI with multivessel CAD increases major bleeding risk, particularly in younger patients (<65 years).
• While potentially reducing recurrent MI, the increased bleeding risk and resource utilization warrant careful consideration.
• Individualized treatment strategies are crucial for optimizing outcomes in this patient population.