Immediate versus staged complete revascularisation in patients presenting with acute coronary syndrome and multivessel coronary disease (BIOVASC): a prospective, open-label, non-inferiority, randomised trial

Diletti, Roberto; Dekker, Wijnand K. den; Bennett, Johan; Schotborgh, Carl E.; Schaaf, René van der; Sabaté, Manel; Moreno, Renata; Ameloot, Koen; Bommel, Rutger van; Forlani, D; Reet, Bert van; Esposito, Giovanni; Dirksen, Maurits T.; Ruifrok, W. P.; Everaert, Bert; Mieghem, Carlos Van; Elscot, Jacob J; Cummins, Paul; Lenzen, Mattie J.; Brugaletta, Salvatore; Boersma, Eric; Mieghem, Nicolás M. Van

doi:10.1016/s0140-6736(23)00351-3

Cited by 97 publications

(54 citation statements)

References 35 publications

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“…In terms of critical complications associated with open heart surgery, the results were favourable. 4,5,[9][10][11] Only four patients experienced AKI, three patients had TIA, and no instances of stroke were observed among the patients. These findings suggest that complete surgical revascularization in patients with NSTE-ACS and UA can be performed with a high degree of procedural success and acceptable rates of complications such as AKI, TIA and stroke.…”

Section: Discussionmentioning

confidence: 93%

“…3,8 However, recent studies and guidelines have reignited the applicability of complete revascularization and CABG in patients with NSTE-ACS. 2,[9][10][11] Notably, while the advantages of complete revascularization, particularly in patients with multivessel coronary artery disease, are well-known, there have been publications indicating the feasibility of surgery in these patients. [9][10][11] In our study, we examined the procedural results of complete surgical revascularization in patients with NSTE-ACS and UA.…”

Section: Discussionmentioning

confidence: 99%

“…2,[9][10][11] Notably, while the advantages of complete revascularization, particularly in patients with multivessel coronary artery disease, are well-known, there have been publications indicating the feasibility of surgery in these patients. [9][10][11] In our study, we examined the procedural results of complete surgical revascularization in patients with NSTE-ACS and UA. The findings showed that, on average, 3.4 distal anastomoses were performed per patient, with an average procedural duration of one hour and twenty-four minutes.…”

Section: Discussionmentioning

confidence: 99%

“…These results demonstrate that complete surgical revascularization is associated with favourable survival rates comparable to existing literature. 4,5,[9][10][11] However, individual patient characteristics and comorbidities should also be considered when interpreting these findings.…”

Section: Discussionmentioning

confidence: 99%

“…2,9–11 Notably, while the advantages of complete revascularization, particularly in patients with multivessel coronary artery disease, are well-known, there have been publications indicating the feasibility of surgery in these patients. 9–11…”

Section: Discussionmentioning

confidence: 99%

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Complete surgical revascularization after NSTEMI and unstable angina in patients with multivessel coronary artery disease: Institutional experience

Kaya,

Bulut,

Candelario

et al. 2023

Asian Cardiovasc Thorac Ann

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Introduction The feasibility and standardization of coronary artery bypass grafting (CABG) in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) and unstable angina (UA) remain topics of ongoing debate. In this study, feasibility and early-term outcomes of CABG in patients with NSTE-ACS and UA were discussed. Methods This study enrolled 79 patients who underwent on-pump CABG with complete revascularization between January 2020 and May 2022. the survival rates analyzed using Kaplan Meier test with log rank test. The p value of statistical significance was taken as below 0.05. Results Preoperatively, the patients had a mean age of 60.9 years and a BMI of 28.0. The medical history included hypertension (50.6%), peripheral arterial disease and atrial fibrillation (12.7%), and other comorbidities such as COPD (22.8%) and type 2 diabetes mellitus (44.3%). Intraoperatively, the mean distal anastomosis count was 3.4, with average cardiopulmonary bypass and aortic cross-clamp times of 84.0 and 49.0 min, respectively. Early-term outcomes revealed low rates of mortality (2.5%) and complications such as myocardial infarction (1.3%), acute kidney injury (5.1%) and transient ischemic attack (5.1%). Post-discharge outcomes demonstrated low cardiac and all-cause mortality rates (2.5% and 3.8%, respectively) and a high overall survival rate (93.7%) at 12-month follow-up. Conclusion This study demonstrated the feasibility and positive outcomes of complete surgical revascularization in patients with UA and NSTE-ACS. It showed no graft occlusion or stroke, low complication rates and promising survival outcomes. Further research is needed for confirmation and to establish the procedure's efficacy and safety in this patient population.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Complete surgical revascularization after NSTEMI and unstable angina in patients with multivessel coronary artery disease: Institutional experience

Kaya,

Bulut,

Candelario

et al. 2023

Asian Cardiovasc Thorac Ann

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Comparison of Multivessel Versus Culprit‐Vessel‐Only Revascularization in Patients With STEMI and Multivessel Disease During Primary PCI: In‐Hospital Outcomes From the CCC‐ACS Project in China

Zhao,

Wang,

et al. 2024

Cathet Cardio Intervent

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BackgroundThe consensus on whether acute ST‐segment elevation myocardial infarction (STEMI) patients with multivessel coronary artery disease (MVD) benefit from complete revascularization during primary percutaneous coronary intervention (PCI) is unclear.AimsThis study aims to assess the impact of multivessel PCI (MV‐PCI) versus culprit‐vessel‐only PCI (CV‐PCI) on in‐hospital outcomes in a Chinese population.MethodsWe evaluated STEMI patients with MVD undergoing PCI, registered in the Improving Care for Cardiovascular Disease in China‐Acute Coronary Syndrome (CCC‐ACS) project, from November 2014 to December 2019. Using inverse probability of treatment weighting (IPTW) and multivariable Cox regression, we compared the incidence of in‐hospital Major Adverse Cardiac Events (MACE) and other adverse clinical outcomes between the MV‐PCI and CV‐PCI groups.ResultsAmong 8138 patients included, 840 (10.3%) underwent MV‐PCI, and 7298 (89.7%) underwent CV‐PCI. MV‐PCI was associated with higher in‐hospital MACE (2.0% vs. 0.9%, p = 0.005), all‐cause mortality (1.7% vs. 0.7%, p = 0.003), and contrast‐induced acute kidney injury (CI‐AKI) (13.6% vs. 10.2%, p = 0.002), after IPTW adjustment. The multivariable Cox analysis further validated the increased risks associated with MV‐PCI.ConclusionIn the Chinese STEMI population with MVD, participating in the CCC‐ACS project, MV‐PCI during primary PCI was linked to higher in‐hospital adverse events compared to CV‐PCI. These findings advocate for a cautious approach to MV‐PCI in this setting, suggesting a potential preference for a staged PCI strategy for nonculprit vessels.Trial RegistrationThe information of clinical trial registration for CCC‐ACS project can be found at http://clinicaltrials.gov/study/NCT02306616

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Impact of Immediate Versus Staged Complete Revascularization on Short‐Term and Long‐Term Clinical Outcomes in Patients With Acute Coronary Syndrome and Multivessel Disease: A Systematic Review and Meta‐Analysis

Jia,

Zuo,

Zhang

et al. 2024

Clinical Cardiology

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BackgroundIn patients with acute coronary syndrome (ACS) and multivessel disease (MVD), complete revascularization (CR) improves prognosis. This meta‐analysis, summarizing recent RCTs, contrasts short‐term and long‐term clinical outcomes between immediate complete revascularization (ICR) and staged complete revascularization (SCR).MethodsWe systematically searched the online database and eight RCTs were involved. The primary outcomes included long‐term unplanned ischemia‐driven revascularization, re‐infarction, combined cardiovascular (CV) death or myocardial infarction (MI), all‐cause death, CV death, stroke, and hospitalization for heart failure (HHF). The secondary outcomes were 1‐month unplanned ischemia‐driven revascularization, re‐infarction, all‐cause death, and CV death. Safety endpoints included stent thrombosis and major bleeding.ResultsEight RCTs comprising 5198 patients were involved. ICR reduced long‐term unplanned ischemia‐driven revascularization (RR 0.64, 95% CI 0.51–0.81, p < 0.001), combined CV death or MI (HR 0.51, 95% CI 0.34–0.78, p = 0.002), and re‐infarction (RR 0.66,95% CI 0.48 to 0.91, p = 0.012) compared with SCR. ICR also decreased 1‐month unplanned ischemia‐driven revascularization (RR 0.41, 95% CI: 0.21–0.77, p = 0.006) and re‐infarction (RR 0.33, 95% CI:0.15–0.74, p = 0.007) but increased 1‐month all‐cause death (RR 2.22, 95% CI 1.06–4.65, p = 0.034).ConclusionIn ACS patients with MVD, we first found that ICR significantly lowered the risk of both short‐term and long‐term unplanned ischemia‐driven revascularization and re‐infarction, as well as the long‐term composite outcome of CV death or MI compared with SCR. However, there may be an increase in 1‐month all‐cause death in the ICR group.

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Immediate versus staged complete revascularisation in patients presenting with acute coronary syndrome and multivessel coronary disease (BIOVASC): a prospective, open-label, non-inferiority, randomised trial

Cited by 97 publications

References 35 publications

Complete surgical revascularization after NSTEMI and unstable angina in patients with multivessel coronary artery disease: Institutional experience

Complete surgical revascularization after NSTEMI and unstable angina in patients with multivessel coronary artery disease: Institutional experience

Comparison of Multivessel Versus Culprit‐Vessel‐Only Revascularization in Patients With STEMI and Multivessel Disease During Primary PCI: In‐Hospital Outcomes From the CCC‐ACS Project in China

Impact of Immediate Versus Staged Complete Revascularization on Short‐Term and Long‐Term Clinical Outcomes in Patients With Acute Coronary Syndrome and Multivessel Disease: A Systematic Review and Meta‐Analysis

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