Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions · 2025
Impact of Complete Revascularization Strategies on the Clinical Outcomes of Patients With Non-ST-Segment Elevation Myocardial Infarction and Multivessel Disease: Multicentre Real-World Evidence From China.
СтатьяМногоцентровое исследованиеСравнительное исследованиеНаблюдательное исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
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Rao Chongyou, Zhong Qin, Li Zongren, Fu Liqiang, Liu Wei, Qin Wei, Gao Jixian, Liu Bo, He Kunlun, Zhou Feihu
Аннотация
BACKGROUND: The prognostic impact of complete revascularization in patients with non-ST-segment elevation myocardial infarction (NSTEMI) and multivessel disease (MVD) remains uncertain.
AIMS: This study aimed to compare clinical outcomes between complete and incomplete revascularization in NSTEMI patients with MVD, assessing the optimal timing and strategy for revascularization.
METHODS: We analyzed 2460 consecutive NSTEMI patients with MVD enrolled across five institutions between January 2021 and December 2022. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCEs: all-cause death, recurrent myocardial infarction, heart failure, stroke, and urgent revascularization) and major adverse cardiac events (MACEs: cardiovascular death, recurrent myocardial infarction, heart failure, and urgent revascularization). Multivariable Cox proportional hazards regression analysis was conducted to adjust for important clinical characteristics, and adjusted hazard ratio (aHR) with a 95% confidence interval (CI) was calculated to assess the risk of clinical outcomes. Inverse probability weighting analysis was performed to verify the robustness of the results.
RESULTS: Over a median 528-day follow-up, complete revascularization was associated with a significantly lower risk of MACCEs (aHR 0.48, 95% CI 0.36-0.64) and MACEs (aHR 0.45, 95% CI 0.33-0.60) compared to incomplete revascularization. Single-stage and multistage complete revascularization showed comparable outcomes (MACCEs: aHR 0.93, 95% CI 0.47-1.85; MACEs: aHR 0.89, 95% CI 0.44-1.82). However, compared to delayed multistage complete revascularization, early multistage complete revascularization significantly reduced the risk of MACCEs (aHR 0.05, 95% CI 0.01-0.28) and MACEs (aHR 0.03, 95% CI 0.01-0.27). These results were consistent after confounder adjustment by inverse probability weighting analysis.
CONCLUSION: Complete revascularization is an effective treatment strategy for reducing the risk of adverse clinical outcomes in NSTEMI patients with MVD. Moreover, an early multistage complete revascularization may be a better option.
AIMS: This study aimed to compare clinical outcomes between complete and incomplete revascularization in NSTEMI patients with MVD, assessing the optimal timing and strategy for revascularization.
METHODS: We analyzed 2460 consecutive NSTEMI patients with MVD enrolled across five institutions between January 2021 and December 2022. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCEs: all-cause death, recurrent myocardial infarction, heart failure, stroke, and urgent revascularization) and major adverse cardiac events (MACEs: cardiovascular death, recurrent myocardial infarction, heart failure, and urgent revascularization). Multivariable Cox proportional hazards regression analysis was conducted to adjust for important clinical characteristics, and adjusted hazard ratio (aHR) with a 95% confidence interval (CI) was calculated to assess the risk of clinical outcomes. Inverse probability weighting analysis was performed to verify the robustness of the results.
RESULTS: Over a median 528-day follow-up, complete revascularization was associated with a significantly lower risk of MACCEs (aHR 0.48, 95% CI 0.36-0.64) and MACEs (aHR 0.45, 95% CI 0.33-0.60) compared to incomplete revascularization. Single-stage and multistage complete revascularization showed comparable outcomes (MACCEs: aHR 0.93, 95% CI 0.47-1.85; MACEs: aHR 0.89, 95% CI 0.44-1.82). However, compared to delayed multistage complete revascularization, early multistage complete revascularization significantly reduced the risk of MACCEs (aHR 0.05, 95% CI 0.01-0.28) and MACEs (aHR 0.03, 95% CI 0.01-0.27). These results were consistent after confounder adjustment by inverse probability weighting analysis.
CONCLUSION: Complete revascularization is an effective treatment strategy for reducing the risk of adverse clinical outcomes in NSTEMI patients with MVD. Moreover, an early multistage complete revascularization may be a better option.