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

Michał Hawranek; Piotr Desperak; Paweł Gąsior; Aneta Desperak; Andrzej Lekston; Mariusz Gąsior

doi:10.5114/aic.2018.74353

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

Postepy Kardiol Interwencyjnej. 2018;14(1):32-41. doi: 10.5114/aic.2018.74353. Epub 2018 Mar 22.

Authors

Michał Hawranek¹, Piotr Desperak¹, Paweł Gąsior¹, Aneta Desperak¹, Andrzej Lekston¹, Mariusz Gąsior²

Affiliations

¹ 3 Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Silesian Centre for Heart Disease in Zabrze, Poland.
² 3 Department of Cardiology, Medical University of Silesia in Katowice, School of Medicine in Katowice, Poland.

Abstract

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.

Keywords: coronary artery revascularization; coronary percutaneous intervention; incomplete coronary revascularization; non-ST segment elevation myocardial infarction.