We present a systematic review and meta-analysis comparing efficacy and safety outcomes
between single procedure multivessel revascularization (MVR) and culprit vessel only
revascularization in patients presenting with non-ST-segment-elevation acute coronary
syndrome (NSTE-ACS). NSTE-ACS is the most common form of acute coronary syndrome (ACS),
and multivessel disease is common. There is no consensus on the most efficacious single
procedure revascularization strategy for patients undergoing percutaneous coronary
intervention not meeting coronary artery bypass grafting criteria. Studies in PubMed
and EMBASE databases were systematically reviewed, and 15 studies met criteria for
inclusion in the meta-analysis. Baseline characteristics between the groups were similar.
A random effects model was used to calculate odds ratios (OR) with 95% confidence
intervals (CI). Heterogeneity of studies was assessed using Cochrane's Q and Higgins
I2 tests. For short-term outcomes, patients who underwent MVR had higher rates of major
adverse cardiac events (OR 1.14; 95% CI 1.01 to 1.29; p = 0.03); and stroke (OR 1.94;
95% CI 1.01 to 3.72; p = 0.05), but lower rates of urgent or emergent coronary artery
bypass grafting (OR 0.35; 95% CI 0.29 to 0.43; p <0.00001). In the long-term, MVR
patients had less frequent major adverse cardiac events (OR 0.76; 95% CI 0.61-0.93;
p = 0.009), all-cause death (OR 0.83; 95% CI 0.71 to 0.97; p = 0.03), and repeat revascularization,
(OR 0.62; 95% CI 0.42 to 0.90; p = 0.01). MVR following NSTE-ACS was associated with
higher short-term risk, but long-term benefit. In conclusion, these results support
the use of single procedure multivessel revascularization for NSTE-ACS patients who
are suitable candidates at the time of percutaneous coronary intervention.
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References
- Heart disease and stroke statistics–2013 update: a report from the American Heart Association.Circulation. 2013; 127: e6-e245
- Heart disease and stroke statistics—2019 update: a report from the American Heart Association.Circulation. 2019; 139: e56-e528
- 2014 AHA/ACC guideline for the management of patients with non–ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association task force on practice guidelines.J Am Coll Cardiol. 2014; 64: e139-e228
- 2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: task force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC).Eur Heart J. 2016; 37: 267-315
- Efficacy and safety of multivessel percutaneous revascularization and tirofiban therapy in patients with acute coronary syndromes.Am J Cardiol. 2002; 90: 631-633
- 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: 293-300
- Culprit-only or multivessel revascularization in patients with acute coronary syndromes.Am Heart J. 2008; 155: 140-146
- Prima-vista multi-vessel percutaneous coronary intervention in haemodynamically stable patients with acute coronary syndromes: analysis of over 4.400 patients in the EHS-PCI registry.Int J Cardiol. 2013; 166: 596-600
- In unstable angina or non–ST-segment acute coronary syndrome, should patients with multivessel coronary artery disease undergo multivessel or culprit-only stenting?.J Am Coll Cardiol. 2007; 49: 849-854
- Complete or incomplete percutaneous coronary revascularization in patients with unstable angina in stent era: Are early and one-year results different?.Catheter Cardiovasc Interv. 2001; 54: 448-453
- Culprit-only or multivessel percutaneous coronary stenting in patients with non-ST-segment elevation acute coronary syndromes: one-year follow-up.J Interv Cardiol. 2009; 22: 329-335
- What is optimal revascularization strategy in patients with multivessel coronary artery disease in non-ST-elevation myocardial infarction? Multivessel or culprit-only revascularization.Int J Cardiol. 2011; 153: 148-153
- Multivessel vs single-vessel revascularization in patients with non–ST-segment elevation acute coronary syndrome and multivessel disease in the drug-eluting stent Era.Clin Cardiol. 2011; 34: 160-165
- Single-vessel or multivessel PCI in patients with multivessel disease presenting with non-ST-elevation acute coronary syndromes.EuroIntervention. 2013; 9: 916-922
- Effect of completeness of revascularization on clinical outcome in patients with multivessel disease presenting with unstable angina who undergo percutaneous coronary intervention.J Invasive Cardiol. 2004; 16: 185-188
- Multivessel vs. culprit-only revascularization in patients with non-ST-elevation acute coronary syndromes and multivessel coronary disease.Revista Portuguesa de Cardiologia. 2018; 37: 143-154
- Complete or incomplete coronary revascularisation in patients with myocardial infarction and multivessel disease: a propensity score analysis from the “real-life” BleeMACS (Bleeding complications in a Multicenter registry of patients discharged with diagnosis of Acute Coronary Syndrome) registry.EuroIntervention. 2017; 13: 407-414
- Complete versus culprit-only lesion intervention in patients with acute coronary syndromes.J Am Coll Cardiol. 2018; 72: 1989-1999
- Multivessel vs culprit-only percutaneous coronary intervention among patients 65 years or older with acute myocardial infarction.Am Heart J. 2016; 172: 9-18
- Meta-analysis of multivessel versus culprit-only percutaneous coronary intervention in patients with non–ST-segment elevation acute coronary syndrome and multivessel coronary disease.Am J Cardiol. 2015; 115: 1027-1032
- A comparison of multivessel and culprit vessel percutaneous coronary intervention in non-ST-segment elevation acute coronary syndrome patients with multivessel disease: a meta-analysis.EuroIntervention. 2015; 11: 525-532
- Contrast-induced nephropathy remains a serious complication of PCI.J Interv Cardiol. 2007; 20: 236-240
- Is complete revascularisation mandated for all patients with multivessel coronary artery disease?.Interv Cardiol. 2018; 13: 45-50
- Optimal timing of complete revascularization in acute coronary syndrome: a systematic review and meta‐analysis.J Am Heart Assoc. 2017; 6
- Meta-analysis of randomized controlled trials comparing multivessel versus culprit-only revascularization for patients with ST-segment elevation myocardial infarction and multivessel disease undergoing primary percutaneous coronary intervention.Am J Cardiol. 2015; 115: 1481-1486
- Meta-analysis of culprit-only versus multivessel percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction and multivessel coronary disease.Am J Cardiol. 2018; 121: 529-536
- Quantification and impact of untreated coronary artery disease after percutaneous coronary intervention: the residual SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) Score.J Am Coll Cardiol. 2012; 59: 2165-2174
- Identifying the infarct-related artery in patients with non–ST-segment–elevation myocardial infarction.Circ Cardiovasc Interv. 2019; 12e007305
- 2014 ESC/EACTS guidelines on myocardial revascularization: the task force on myocardial revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI).Eur Heart J. 2014; 35: 2541-2619
Article Info
Publication History
Published online: August 29, 2019
Received in revised form:
July 30,
2019
Received:
May 29,
2019
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
