Long Term Changes ACS Revascularization

Long term outcomes support complete revascularization in multivessel patients undergoing acute coronary syndrome (ACS).

This large contemporary registry recently published in J Am Coll Cardiol Intv.  has shown complete revascularization is gaining ground in the daily practice and is associated to clinical benefits in patients undergoing ACS. 

It included 9094 individuals with ACS and multivessel disease (>70% stenosis in 2 or more epicardial vessels) receiving PCI.

It looked at the link between complete revascularization and all cause death and repeat MI vs. incomplete revascularization.

66% of all patients received complete revascularization. These were compared against the remaining 34%.

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Primary end point at 5 years was frequent in those undergoing complete revascularization (15.4% vs. 22.2%; HR: 0.78; CI 95%:0.73 to 0.84; p<0.0001).

Repeat revascularization combined with all cause death and infarction was among the secondary end points and also resulted better with complete revascularization (23.3% vs. 37.5%; HR: 0.61; CI 95%: 0.58 to 0.65; p<0.0001).

Each of the above mentioned points were looked at separately and also resulted significantly superior with complete revascularization: all cause death (HR: 0.79; CI 95%: 0.73 to 0.86; p=0.0004), repeat MI (HR: 0.76; CI 95%: 0.69 to 0.84; p<0.0001) and repeat revascularization (HR: 0.53; CI 95%: 0.49 to 0.57; p<0.0001).

Conclusion

The 5-year outcomes of this large contemporary registry of ACS patients with multivessel disease suggest complete revascularization is habitual in the daily clinical practice and is associated with significant benefits as regards the main clinical end points. 

Original Title: Long-Term Outcomes of Complete Revascularization With Percutaneous Coronary Intervention in Acute Coronary Syndromes.

Reference: Kevin R. Bainey et al. J Am Coll Cardiol Intv 2020;13:1557–67. https://doi.org/10.1016/j.jcin.2020.04.034.

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