Early and long-term outcomes of complete revascularization with percutaneous coronary intervention in patients with multivessel coronary artery disease presenting with non-ST-segment elevation acute coronary syndromes

摘要

Introduction The clinical significance of complete revascularization with percutaneous coronary intervention (CR-PCI) in patients with non-ST-segment acute coronary syndrome (NSTE-ACS) remains uncertain. Aim To evaluate the impact of CR-PCI during index hospitalization on short and long-term incidence of death and composite endpoint among patients with multivessel coronary artery disease (CAD) presenting with NSTE-ACS. Material and methods We analyzed consecutive data of 1,592 patients with multivessel CAD from 2006 to 2014. Patients with prior coronary artery bypass grafting (CABG), cardiogenic shock, treated conservatively or with CABG and scheduled for planned CABG or PCI after discharge were excluded. The 30-day and 12-month composite endpoint was defined as all-cause death, nonfatal myocardial infarction (MI) or ACS-driven unplanned revascularization. Six hundred and ninety-five patients were divided into 2 groups: CR-PCI (n = 137) (CR-PCI during index hospitalization) and IR-PCI (n = 558) (incomplete revascularization). Results Incidence of composite endpoint (3.6% vs. 10.2%; HR = 0.31; 95% CI: 0.12–0.87; p = 0.025) and death (0.7% vs. 5.7%, HR = 0.11; 95% CI: 0.02–0.93; p = 0.043) at 30 days was lower in CR-PCI than in IR-PCI. At 12-month follow-up occurrence of composite endpoint was lower in CR-PCI (14.7%) than in IR-PCI (27.4%, p = 0.0037). Multivariate analysis confirmed that CR PCI was associated with a reduction in 12-month composite endpoint (HR = 0.56; 95% CI: 0.31–0.99; p = 0.046). The 12-month mortality was lower in CR-PCI (7.4% vs. 14.8%; p = 0.031), but it was not confirmed in the multivariate analysis. Conclusions In patients with multivessel CAD and NSTE-ACS, CR-PCI during index hospitalization was independently associated with improved early and long-term prognosis without significant differences in periprocedural outcomes in comparison to IR-PCI.