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Prognostic impact of multivessel versus culprit vessel only percutaneous intervention for patients with multivessel coronary artery disease presenting with acute coronary syndrome.
EuroIntervention. 2015 Jul; 11(3):293-300.E

Abstract

AIMS

To determine whether multivessel (MV) percutaneous coronary intervention (PCI) performed in one procedure improves outcomes when compared to single-vessel (SV) PCI for the culprit lesion(s) in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS).

METHODS AND RESULTS

We utilised the Acute Catheterisation and Urgent Intervention Triage StrategY (ACUITY) study database to analyse the outcomes of 2,255 patients with MV disease who underwent SV PCI compared to 609 patients who underwent MV PCI in the setting of NSTE-ACS. The primary endpoint was the one-year rate of major adverse cardiac events (MACE): death from any cause, myocardial infarction (MI), or ischaemia-driven revascularisation. At one year, patients undergoing MV PCI compared to SV PCI had similar rates of MACE (24.1% vs. 21.7%, respectively, p=0.11). However, death/MI was significantly higher in the MV PCI group (15.7% vs. 12.6%, p=0.05), primarily driven by higher rates of periprocedural non-Q-wave MI. Rates of death, ischaemia-driven revascularisation, stent thrombosis, acute renal failure and major bleeding were similar in both groups. By multivariable analysis with propensity score adjustment, MV PCI was not an independent predictor of one-year MACE (HR=1.22; 95% confidence interval [CI]: 0.96, 1.55; p=0.12) or death/MI (HR=1.28; 95% CI: 0.95, 1.74; p=0.15).

CONCLUSIONS

In patients with NSTE-ACS and MV disease, MV PCI does not appear to provide a clear clinical benefit over SV PCI. Randomised clinical trials specifically addressing these two strategies in this population, with attention to quality of life and symptom relief, are warranted.

Authors+Show Affiliations

Morristown Medical Center, Morristown, NJ, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25136882

Citation

Hassanin, Ahmed, et al. "Prognostic Impact of Multivessel Versus Culprit Vessel Only Percutaneous Intervention for Patients With Multivessel Coronary Artery Disease Presenting With Acute Coronary Syndrome." EuroIntervention : Journal of EuroPCR in Collaboration With the Working Group On Interventional Cardiology of the European Society of Cardiology, vol. 11, no. 3, 2015, pp. 293-300.
Hassanin A, Brener SJ, Lansky AJ, et al. Prognostic impact of multivessel versus culprit vessel only percutaneous intervention for patients with multivessel coronary artery disease presenting with acute coronary syndrome. EuroIntervention. 2015;11(3):293-300.
Hassanin, A., Brener, S. J., Lansky, A. J., Xu, K., & Stone, G. W. (2015). Prognostic impact of multivessel versus culprit vessel only percutaneous intervention for patients with multivessel coronary artery disease presenting with acute coronary syndrome. EuroIntervention : Journal of EuroPCR in Collaboration With the Working Group On Interventional Cardiology of the European Society of Cardiology, 11(3), 293-300. https://doi.org/10.4244/EIJY14M08_05
Hassanin A, et al. Prognostic Impact of Multivessel Versus Culprit Vessel Only Percutaneous Intervention for Patients With Multivessel Coronary Artery Disease Presenting With Acute Coronary Syndrome. EuroIntervention. 2015;11(3):293-300. PubMed PMID: 25136882.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prognostic impact of multivessel versus culprit vessel only percutaneous intervention for patients with multivessel coronary artery disease presenting with acute coronary syndrome. AU - Hassanin,Ahmed, AU - Brener,Sorin J, AU - Lansky,Alexandra J, AU - Xu,Ke, AU - Stone,Gregg W, PY - 2014/8/20/entrez PY - 2014/8/20/pubmed PY - 2016/8/9/medline SP - 293 EP - 300 JF - EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology JO - EuroIntervention VL - 11 IS - 3 N2 - AIMS: To determine whether multivessel (MV) percutaneous coronary intervention (PCI) performed in one procedure improves outcomes when compared to single-vessel (SV) PCI for the culprit lesion(s) in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS). METHODS AND RESULTS: We utilised the Acute Catheterisation and Urgent Intervention Triage StrategY (ACUITY) study database to analyse the outcomes of 2,255 patients with MV disease who underwent SV PCI compared to 609 patients who underwent MV PCI in the setting of NSTE-ACS. The primary endpoint was the one-year rate of major adverse cardiac events (MACE): death from any cause, myocardial infarction (MI), or ischaemia-driven revascularisation. At one year, patients undergoing MV PCI compared to SV PCI had similar rates of MACE (24.1% vs. 21.7%, respectively, p=0.11). However, death/MI was significantly higher in the MV PCI group (15.7% vs. 12.6%, p=0.05), primarily driven by higher rates of periprocedural non-Q-wave MI. Rates of death, ischaemia-driven revascularisation, stent thrombosis, acute renal failure and major bleeding were similar in both groups. By multivariable analysis with propensity score adjustment, MV PCI was not an independent predictor of one-year MACE (HR=1.22; 95% confidence interval [CI]: 0.96, 1.55; p=0.12) or death/MI (HR=1.28; 95% CI: 0.95, 1.74; p=0.15). CONCLUSIONS: In patients with NSTE-ACS and MV disease, MV PCI does not appear to provide a clear clinical benefit over SV PCI. Randomised clinical trials specifically addressing these two strategies in this population, with attention to quality of life and symptom relief, are warranted. SN - 1969-6213 UR - https://www.unboundmedicine.com/medline/citation/25136882/Prognostic_impact_of_multivessel_versus_culprit_vessel_only_percutaneous_intervention_for_patients_with_multivessel_coronary_artery_disease_presenting_with_acute_coronary_syndrome_ L2 - http://www.pcronline.com/eurointervention/ahead_of_print/201408-05 DB - PRIME DP - Unbound Medicine ER -