Culprit‐Only or Multivessel Percutaneous Coronary Stenting in Patients with Non‐ST‐Segment Elevation Acute Coronary Syndromes: One‐Year Follow‐Up

Zapata, Gerardo; Lasave, Leandro; Kozak, Fernando; Damonte, Aníbal; Meiriño, Alejandro; Rossi, Maximiliano; Carbó, Sabrina; Pollice, Analia; Paolasso, Ernesto; Picabea, Eduardo

doi:10.1111/j.1540-8183.2009.00477.x

Cited by 46 publications

(36 citation statements)

References 19 publications

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“…These results were agreed with the present study. In agreement with our study, Zapata et al [14] investigated the major cardiac events at 1-year follow-up of multi-vessel versus culprit-vessel stenting in patients presenting with NSTE-ACS and multi-vessel disease (MVD). The incidence of MACE was lower in MVR (9.45% vs. 16.34%, P = 0.02) with lower revascularization rate (7.46% vs. 13.86%, P = 0.04) than in CVR.…”

Section: Discussionsupporting

confidence: 60%

Multivessel Stenting versus Culprit-Only Stenting in Multivessel Coronary Artery Disease Patients Presented with Non-ST-Segment Elevation Acute Coronary Syndrome (NSTE-ACS)

Salem¹

2015

JCCR

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Section: Discussionsupporting

confidence: 60%

Multivessel Stenting versus Culprit-Only Stenting in Multivessel Coronary Artery Disease Patients Presented with Non-ST-Segment Elevation Acute Coronary Syndrome (NSTE-ACS)

Salem¹

2015

JCCR

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“…6 However, few studies have compared outcomes of MVR and SVR in these patients undergoing PCI. 7,8,12 Results from previous studies are controversial. Moreover, these studies were conducted before the introduction of DES and cannot reflect current practice.…”

Section: Discussionmentioning

confidence: 99%

“…These results were consistent with the results from previous studies with bare-metal stents on the same topic. 7,8 Because selection of treatment strategy is apt to be strongly affected by jeopardized myocardial territory and lesion complexity, we investigated whether the benefit of MVR might differ according to the APPROACH lesion score and the SYNTAX score. Although the SYNTAX score did not affect treatment strategy, the APPROACH lesion score was associated with the performance of MVR.…”

Section: Discussionmentioning

confidence: 99%

“…Few studies have compared long-term outcomes of multivessel revascularization (MVR) and single-vessel revascularization (SVR) in patients with NSTE-ACS and MVD undergoing PCI. 7,8 Moreover, these studies were conducted in the era of bare-metal stents. Therefore, we sought to compare longterm outcomes for MVR vs SVR using drug-eluting stents (DES) in patients with NSTE-ACS and MVD.…”

Section: Introductionmentioning

confidence: 99%

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Multivessel vs Single‐Vessel Revascularization in Patients With Non–ST‐Segment Elevation Acute Coronary Syndrome and Multivessel Disease in the Drug‐Eluting Stent Era

Lee

Song

Hahn

et al. 2011

Clinical Cardiology

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Background: We sought to compare long-term outcomes for multivessel revascularization (MVR) vs singlevessel revascularization (SVR) with drug-eluting stents (DES) in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and multivessel coronary artery disease (MVD). Hypothesis: In DES era, MVR would improve long-term clinical outcomes in patients with NSTE-ACS. Methods: We studied 179 patients undergoing MVR and 187 patients undergoing SVR for NSTE-ACS and MVD. Major adverse cardiac events (MACE) were defined as death, myocardial infarction, or any revascularization. ) and myocardial infarction (HR: 0.39, 95% CI: 0.11-1.47). The incidence of periprocedural renal dysfunction was not significantly different between patients undergoing MVR vs SVR (3.4% vs 1.6%, P = 0.33). Definite or probable stent thrombosis occurred at a similar rate (2.2% in the MVR group and 2.7% in the SVR group, P = 0.99). Conclusions:In patients with NSTE-ACS and MVD, MVR using drug-eluting stents may reduce MACE. Our findings should be confirmed by a prospective, randomized trial.

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“…12 Several observational single-center studies have also reported lower rates of MACE in patients with NSTEACS and multivessel disease who underwent CR with drug-eluting stents compared with culprit lesion revascularization only. 22,23 However, none of these studies were randomized, and it is possible that residual confounding (eg, the extent of atherosclerosis) explains the worse prognosis in patients with ICR. Treating additional nonculprit lesions in ACS to achieve CR would likely entail some excess risk of procedural complications and additional cost.…”

Section: Clinical Implications and Future Directionsmentioning

confidence: 99%

Impact of the Presence and Extent of Incomplete Angiographic Revascularization After Percutaneous Coronary Intervention in Acute Coronary Syndromes

et al. 2012

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Background-The clinical significance of incomplete coronary revascularization (ICR) after percutaneous coronary intervention in patients with acute coronary syndromes is unknown. Methods and Results-We performed quantitative angiography of the entire coronary tree in 2954 patients with acute coronary syndromes in the Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) trial. ICR was variably defined if any lesion with diameter stenosis (DS) cutoffs ranging from Ն30% to Ն70% with reference vessel diameter Ն2.0 mm remained after percutaneous coronary intervention. The primary outcome was 1-year composite rate of major adverse cardiac events (death, myocardial infarction, or ischemia-driven unplanned revascularization). With the use of DS cutoffs Ն30%, Ն40%, Ն50%, Ն60%, and Ն70%, the prevalence of ICR after percutaneous coronary intervention was 75%, 55%, 37%, 25%, and 17%, respectively. The 1-year major adverse cardiac event rate was increased among patients with ICR using all of the DS cutoffs. ICR (Ն50% DS) was associated with higher 1-year rates of myocardial infarction (12.0% versus 8.2%; hazard ratio, 1.50; 95% confidence interval, 1.18 -1.89; Pϭ0.0007) and ischemia-driven unplanned revascularization (15.7% versus 10.2%; hazard ratio, 1.58; 95% confidence interval, 1.28 -1.96; PϽ0.0001), with a trend toward increased mortality (3.1% versus 2.2%; hazard ratio, 1.43; 95% confidence interval, 0.90 -2.27; Pϭ0.13). By multivariable analysis, ICR (Ն50% DS) was an independent predictor of 1-year major adverse cardiac events (hazard ratio, 1.36; 95% confidence interval, 1.12-1.64; Pϭ0.002). The impact of ICR on major adverse cardiac events was similar regardless of chronic total occlusion presence, but it was more pronounced with a greater number of nonrevascularized lesions. Conclusions-Depending on the threshold of percent DS, ICR was present in 17% to 75% of patients with acute coronary syndromes after percutaneous coronary intervention. Regardless of the threshold, ICR was strongly associated with 1-year myocardial infarction, ischemia-driven unplanned revascularization, and major adverse cardiac events. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00093158.

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Culprit‐Only or Multivessel Percutaneous Coronary Stenting in Patients with Non‐ST‐Segment Elevation Acute Coronary Syndromes: One‐Year Follow‐Up

Abstract: Multivessel stenting in patients with NSTE-ACS and multivessel disease using a clinical decision of treatment is associated with lower rate of MACE driven by lower repeat revascularization, compared with culprit-vessel stenting, without difference in rates of death or MI.

Cited by 46 publications

References 19 publications

Multivessel Stenting versus Culprit-Only Stenting in Multivessel Coronary Artery Disease Patients Presented with Non-ST-Segment Elevation Acute Coronary Syndrome (NSTE-ACS)

Multivessel Stenting versus Culprit-Only Stenting in Multivessel Coronary Artery Disease Patients Presented with Non-ST-Segment Elevation Acute Coronary Syndrome (NSTE-ACS)

Multivessel vs Single‐Vessel Revascularization in Patients With Non–ST‐Segment Elevation Acute Coronary Syndrome and Multivessel Disease in the Drug‐Eluting Stent Era

Impact of the Presence and Extent of Incomplete Angiographic Revascularization After Percutaneous Coronary Intervention in Acute Coronary Syndromes

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