Total revascularization in acute coronary syndrome patients with multivessel disease and major adverse events during long-term follow-up

    Authors

    Keywords

    acute coronary syndrome, percutaneous coronary intervention, multivessel disease

    DOI

    https://doi.org/10.15836/ccar2023.55

    Full Text

    Introduction : Multivessel disease is often found during coronary angiography and percutaneous coronary intervention (PCI) in acute coronary syndromes (ACS). Routine revascularization in angiographically significant by-stander coronary lesions is considered to be a standard after culprit lesion PCI and has been linked with better outcomes. ( 1 ) We wanted to investigate differences in outcomes after total and non-total revascularization among different subsets of patients (ST elevation myocardial infarction [STEMI] vs non-ST-elevation myocardial infarction [NSTEMI]). Patients and Methods : Among 1081 patients (72% males, 58% with STEMI, 22% with diabetes) who received PCI in ACS, and were discharged in stable condition between 2018 and 2020, we analyzed data on coronary artery disease burden, the completeness of revascularization and outcomes (death and MACE as composite of cardiac death, myocardial infarction, any unplanned revascularization, stroke, symptomatic heart failure and clinically relevant bleeding) during a mean follow-up of 44 months. Results : Patients with STEMI had significantly lower proportion (17% vs 30%) of multivessel disease/left main disease (MVD/LM) and significantly lower mean Syntax scores (11 vs 14) in comparison to NSTEMI patients. Total revascularization (ad hoc or staged) was achieved more often in STEMI than in NSTEMI (77% vs 65%). Among STEMI patients, there were no differences in death or MACE in regard to completeness of revascularization. However, NSTEMI patients who received total revascularization had significantly higher overall survival rate during follow-up (97% vs 90%, p=0.006) in comparison to patients without total revascularization. There were no differences in occurrence of MACE among NSTEMI patients during follow-up in regard to the completeness of revascularization. Conclusion : Complete revascularization did not show to influence outcomes in STEMI, where multivessel disease was less present. However, in NSTEMI patients with more frequent multivessel disease, complete revascularization was linked with longer overall survival after ACS.

    Cardiologia Croatica
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    Total revascularization in acute coronary syndrome patients with multivessel disease and major adverse events during long-term follow-up

    Extended Abstract
    Issue3-4
    Published
    Pages55
    PDF via DOIhttps://doi.org/10.15836/ccar2023.55
    acute coronary syndrome
    percutaneous coronary intervention
    multivessel disease

    Authors

    Irzal Hadžibegović*University Hospital Dubrava, Zagreb, Croatia
    Ivana JurinUniversity Hospital Dubrava, Zagreb, Croatia
    Petra VitlovUniversity Hospital Dubrava, Zagreb, Croatia
    Anđela JurišićUniversity Hospital Dubrava, Zagreb, Croatia
    Miroslav RagužUniversity Hospital Dubrava, Zagreb, Croatia
    Ilko VuksanovićUniversity Hospital Dubrava, Zagreb, Croatia
    Mario UdovičićUniversity Hospital Dubrava, Zagreb, Croatia
    Ante LisičićUniversity Hospital Dubrava, Zagreb, Croatia
    Tomislav ŠipićUniversity Hospital Dubrava, Zagreb, Croatia
    Nikola PavlovićUniversity Hospital Dubrava, Zagreb, Croatia
    Marin PavlovUniversity Hospital Dubrava, Zagreb, Croatia
    Aleksandar BlivajsUniversity Hospital Dubrava, Zagreb, Croatia
    Tomislava Bodrožić Džakić PoljakUniversity Hospital Dubrava, Zagreb, Croatia
    Šime ManolaUniversity Hospital Dubrava, Zagreb, Croatia

    Full Text

    Introduction : Multivessel disease is often found during coronary angiography and percutaneous coronary intervention (PCI) in acute coronary syndromes (ACS). Routine revascularization in angiographically significant by-stander coronary lesions is considered to be a standard after culprit lesion PCI and has been linked with better outcomes. ( 1 ) We wanted to investigate differences in outcomes after total and non-total revascularization among different subsets of patients (ST elevation myocardial infarction [STEMI] vs non-ST-elevation myocardial infarction [NSTEMI]). Patients and Methods : Among 1081 patients (72% males, 58% with STEMI, 22% with diabetes) who received PCI in ACS, and were discharged in stable condition between 2018 and 2020, we analyzed data on coronary artery disease burden, the completeness of revascularization and outcomes (death and MACE as composite of cardiac death, myocardial infarction, any unplanned revascularization, stroke, symptomatic heart failure and clinically relevant bleeding) during a mean follow-up of 44 months. Results : Patients with STEMI had significantly lower proportion (17% vs 30%) of multivessel disease/left main disease (MVD/LM) and significantly lower mean Syntax scores (11 vs 14) in comparison to NSTEMI patients. Total revascularization (ad hoc or staged) was achieved more often in STEMI than in NSTEMI (77% vs 65%). Among STEMI patients, there were no differences in death or MACE in regard to completeness of revascularization. However, NSTEMI patients who received total revascularization had significantly higher overall survival rate during follow-up (97% vs 90%, p=0.006) in comparison to patients without total revascularization. There were no differences in occurrence of MACE among NSTEMI patients during follow-up in regard to the completeness of revascularization. Conclusion : Complete revascularization did not show to influence outcomes in STEMI, where multivessel disease was less present. However, in NSTEMI patients with more frequent multivessel disease, complete revascularization was linked with longer overall survival after ACS.