J Cardiovasc Interv.  2022 Apr;1(2):72-81. 10.54912/jci.2022.0003.

Association of Timing of Revascularization on Clinical Outcomes of Percutaneous Coronary Intervention Relative to Surgery in Non-ST-Elevation Acute Coronary Syndrome Patients With Multivessel Disease

• Lim C
• Hong SJ
• Kim BK
• Lee YJ
• Lee SJ
• Suh Y
• Ahn CM
• Kim JS
• Hong MK
• Jang Y

• KMID: 2561244
• DOI: http://doi.org/10.54912/jci.2022.0003

Abstract

Background
We aimed to evaluate the association of percutaneous coronary intervention (PCI) relative to coronary artery bypass graft (CABG) according to the timing of revascularization in patients with multivessel-disease non-ST-elevation acute coronary syndrome (NSTE-ACS).
Methods
A total of 1,226 multivessel-disease NSTE-ACS patients who received revascularizations with PCI or CABG between 2005 and 2011, were retrospectively analyzed. The 3-year composite of cardiac death and myocardial infarction (MI) were compared between PCI and CABG according to the timing of revascularization; < 48 hours (n = 544), and ≥ 48 hours (n = 682).
Results
Proportion of patients who received PCI gradually decreased from group 1 to group 5 (80%, 84%, 62%, 41%, and 15%; P < 0.001), indicating faster revascularization in PCI than CABG. Although the composite of cardiac death and MI at 3 years was significantly higher in PCI versus CABG (adjusted hazard ratio [aHR], 3.17; 95% confidence interval [CI], 1.45–6.93; P = 0.004) for patients receiving revascularization ≥ 48 hours, it was not significantly different between groups at 3 years for patients receiving revascularization < 48 hours (aHR, 0.66; 95% CI, 0.34–1.29; P = 0.224). A significant interaction between the timing of revascularization and its strategy as for 3-year composite of cardiac death and MI was observed (P-_interaction = 0.023).
Conclusions
The association of PCI relative to CABG was different according to the timing of revascularization. In clinical situations, the appropriate timing of revascularization (early versus delayed) and the revascularization strategy (PCI versus CABG) need to be simultaneously considered in patients with multivessel-disease NSTE-ACS.

Keyword

Percutaneous coronary intervention; Coronary artery bypass surgery; Acute coronary syndrome