Multivessel versus Culprit-Only Percutaneous Coronary Intervention in Patients with Non-ST-Elevation Acute Coronary Syndrome

• Published in: Journal of clinical medicine Vol. 11; no. 20; p. 6144
• Main Authors: Pustjens, Tobias F S, Timmermans, Marijke J C, Rasoul, Saman, van 't Hof, Arnoud W J, On Behalf Of The Pci Registration Committee, The Cardiothoracic Surgery Registration Committee Of The Netherlands Heart Registration
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 18.10.2022; MDPI
• Subjects: Acute coronary syndromes; Angioplasty; Cardiovascular disease; Clinical medicine; Coronary vessels; Datasets; Diabetes; Ejection fraction; Gender; Heart attacks; Medical prognosis; Mortality; multivessel disease; myocardial infarction; NSTE-ACS; Patients; PCI; Statistical analysis; Variables; Netherlands; NSTE-ACS; PCI; multivessel disease; myocardial infarction
• ISSN: 2077-0383; 2077-0383
• DOI: 10.3390/jcm11206144

Background: There is uncertainty whether multivessel (MV-PCI) or culprit-only percutaneous coronary intervention (CO-PCI) should be the treatment of choice in patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS) and multivessel disease (MVD). Aims: To evaluate clinical characteristics and outcomes in these patients undergoing MV-PCI or CO-PCI at the index procedure. Methods: Data were retrieved from the nationwide Netherlands Heart Registration. All NSTE-ACS patients with MVD undergoing PCI between 1 January 2017 and 1 October 2019 were grouped into a MV-PCI or CO-PCI group. The primary endpoint was all-cause mortality at long-term follow-up (median 756 days (593−996)). Secondary endpoints were reinterventions, urgent CABG, myocardial infarction (MI) < 30 days, target vessel revascularisation (TVR) and mortality at 1 year. Propensity score matching analyses were performed. Results: In total, 10,507 NSTE-ACS patients with MVD were included into the MV-PCI (N = 4235) and CO-PCI group (N = 6272). Analysing crude data, mortality rates at long-term follow-up (10.7% vs. 10.2%; p = 0.383), mortality at 1 year (6.0% vs. 5.6%; p = 0.412) and MI <30 days (0.8% vs. 0.9%; p = 0.513) were similar between both groups. Reinterventions (11.1% vs. 20.0%; p < 0.001), urgent CABG (0.1% vs. 0.4%; p = 0.001) and TVR (5.2% vs. 6.7%; p = 0.003) occurred less often in the MV-PCI group. Survival analysis after multiple imputation and propensity score matching showed similar mortality rates at long-term follow-up (log-rank p = 0.289), but a significant reduction for reinterventions in the MV-PCI group (log-rank p < 0.001). Conclusion: NSTE-ACS patients with MVD undergoing MV-PCI have similar mortality rates at long-term follow-up compared to CO-PCI. However, improved event-free survival in terms of fewer coronary reinterventions was observed.