Complete versus culprit-only revascularization in non-ST-segment elevation myocardial infarction and multivessel coronary artery disease

Abstract

Introduction/Objective The optimal percutaneous coronary intervention (PCI) in patients with non-ST-elevated myocardial infarction (NSTEMI) and multivessel coronary artery disease (CAD) is still not clear. The aim of our study was to examine intrahospital and long-term major adverse cardiovascular and cerebrovascular events (MACCE) in this group of patients.

Methods This retrospective study included 225 patients with NSTEMI and multivessel CAD treated with PCI at the Institute of Cardiovascular Diseases of Vojvodina. Three groups were formed: complete one-stage PCI; complete multi-stage PCI, and culprit-only PCI. We analyzed intrahospital and one-year follow-up MACCE and mortality after three years in all three groups.

Results Complete one-stage PCI was performed in 112 (49.8%), complete multi-stage PCI in 70 (31.3%), and culprit-only PCI in 43 (19.1%) patients. Patients with multi-stage complete PCI had the lowest mortality in comparison with one-stage and culprit-only PCI, both intrahospital (0% vs. 0.9% and 20.9%, respectively, p < 0.0005) and after one year (0% vs. 2.7% and 30.2%, respectively, p < 0.0005) and three years (4.3% vs. 5.4% and 32.6%, respectively, p < 0.0005). There was no significant difference in other MACCE between the groups, both intrahospital and after one year.

Conclusion In our study, multi-stage PCI significantly reduces intrahospital, one-year and three-year follow-up mortality in patients with NSTEMI and multivessel CAD.

Keywords: non-ST-elevated myocardial infarction; multivessel coronary artery disease; percutaneous coronary intervention; major adverse cardiovascular and cerebrovascular events; mortality