Open AccessMultivessel vs Single‐Vessel Revascularization in Patients With Non–ST‐Segment Elevation Acute Coronary Syndrome and Multivessel Disease in the Drug‐Eluting Stent Era
Author(s) -
Lee Hyun Jong,
Song Young Bin,
Hahn JooYong,
Kim Sang Min,
Yang Ji Hyun,
Choi Joon Hyouk,
Choi SeungHyuk,
Choi JinHo,
Lee Sang Hoon,
Gwon HyeonCheol
Publication year - 2011
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.20858
Subject(s) - medicine , mace , cardiology , hazard ratio , myocardial infarction , coronary artery disease , revascularization , acute coronary syndrome , stent , drug eluting stent , percutaneous coronary intervention , surgery , confidence interval
Abstract Background: We sought to compare long‐term outcomes for multivessel revascularization (MVR) vs single‐vessel revascularization (SVR) with drug‐eluting stents (DES) in patients with non–ST‐segment elevation acute coronary syndrome (NSTE‐ACS) and multivessel coronary artery disease (MVD). Hypothesis: In DES era, MVR would improve long‐term clinical outcomes in patients with NSTE‐ACS. Methods: We studied 179 patients undergoing MVR and 187 patients undergoing SVR for NSTE‐ACS and MVD. Major adverse cardiac events (MACE) were defined as death, myocardial infarction, or any revascularization. Results: During follow‐up (median 36 months), MACE occurred in 96 patients (26.2%); 35 (19.6%) in the MVR group and 61 (32.6%) in the SVR group ( P = 0.003). In multivariate analysis, MVR was associated with a lower incidence of MACE (hazard ratio [HR]: 0.50, 95% confidence interval [CI]: 0.30–0.85) and revascularization (HR: 0.43, 95% CI: 0.24–0.78), but not of death (HR: 0.69, 95% CI: 0.25–1.93) and myocardial infarction (HR: 0.39, 95% CI: 0.11–1.47). The incidence of periprocedural renal dysfunction was not significantly different between patients undergoing MVR vs SVR (3.4% vs 1.6%, P = 0.33). Definite or probable stent thrombosis occurred at a similar rate (2.2% in the MVR group and 2.7% in the SVR group, P = 0.99). Conclusions: In patients with NSTE‐ACS and MVD, MVR using drug‐eluting stents may reduce MACE. Our findings should be confirmed by a prospective, randomized trial. © 2011 Wiley Periodicals, Inc. This work was supported by Sungkyunkwan University Foundation for Corporate Collaboration (2008‐1366‐000) and the IN‐SUNG Foundation for Medical Research, Republic of Korea (CA88161). The authors have no other funding, financial relationships, or conflicts of interest to disclose.