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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Article info
Publication history
Published online: August 29, 2019
Received in revised form:
July 30,
2019
Received:
May 29,
2019
Identification
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© 2019 Elsevier Inc. All rights reserved.
