Korean Circ J.  2016 Nov;46(6):774-783. 10.4070/kcj.2016.46.6.774.

"One-Time" versus Staged Multivessel Intervention in Intermediate to Very High-Risk Patients with Non-ST-Segment Elevation Acute Coronary Syndromes

• Yu X
• Li Y
• Wang Q
• Liang M
• Xu K
• Han Y

• KMID: 2355452
• DOI: http://doi.org/10.4070/kcj.2016.46.6.774

Abstract

BACKGROUND AND OBJECTIVES
To compare clinical outcomes of staged versus "one-time" percutaneous coronary intervention (PCI) in intermediate to very high-risk patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) and multivessel coronary disease (MVD).
SUBJECTS AND METHODS
1531 NSTE-ACS patients with multivessel PCI and meeting the criteria of intermediate to very high risk were screened from a prospectively registered database obtained from General Hospital of Shenyang Military Region between 2008 and 2012. They were categorized into "one-time" PCI (n=859) and staged PCI (n=672) according to intervention strategy. The primary outcomes included a 3-year major adverse cardiac event (MACE), a composite of cardiac death, myocardial infarction (MI), and target vessel revascularization.
RESULTS
At 3 years, no significant differences in MACE (20.8% vs. 19.7%, p=0.608) and cardiac death/MI (7.1% vs. 9.1%, p=0.129) were observed between the two groups. After propensity score matching, there was no statistical significance in MACE (18.9% vs. 21.8%, p=0.249); whereas cardiac death/MI was significantly lower in the staged PCI group (7.0% vs.11.1%, p=0.033). Ninety-day landmark analysis showed that the staged PCI group had a lower 90-day incidence of MACE (1.2% vs. 3.3%, p= 0.037) and cardiac death/MI (0.7% vs. 2.6%, p=0.031). For the 90-day to 3-year follow-up period, the incidences of MACE (17.9% vs. 19.1%, p=0.641) and cardiac death/MI (6.3% vs. 8.7%, p=0.191) were similar in both groups.
CONCLUSION
In intermediate- to very high-risk NSTE-ACS patients with MVD, staged PCI is superior to "one-time" PCI in terms of cardiac death/MI.

Keyword

Acute coronary syndromes; Coronary artery disease; Percutaneous coronary intervention

MeSH Terms

Acute Coronary Syndrome*
Coronary Artery Disease
Coronary Disease
Death
Follow-Up Studies
Hospitals, General
Humans
Incidence
Military Personnel
Myocardial Infarction
Percutaneous Coronary Intervention
Propensity Score
Prospective Studies

Figure

• 

  Fig. 1 Patient flow diagram. PCI: percutaneous coronary intervention, STEMI: ST-segment elevation myocardial infarction, CAD: coronary artery disease, NSTE-ACS: non–ST-segment elevation acute coronary syndromes, eGFR: estimated glomerular filtration rate.

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  Fig. 2 Kaplan-Meier assessment of MACE for unadjusted (A) and propensity score matched (B) patients; 90-day landmark analysis of MACE for unadjusted (C) and propensity score matched (D) patients. MACE: major adverse cardiac events, PCI: percutaneous coronary intervention.

• 

  Fig. 3 Kaplan-Meier assessment for the composite of cardiac death or MI for unadjusted (A) and propensity score matched(B) patients; 90-day landmark analysis of the composite of cardiac death or MI for unadjusted (C) and propensity score matched (D) patients. PCI: percutaneous coronary intervention. MI: myocardial infarction.

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