In patients with acute coronary syndrome (ACS) and multivessel disease, complete revascularization is associated with better clinical outcomes. However, for non-culprit vessel revascularization the strategy remains unclear.
The aim of this multicenter, open label, randomized, non-inferiority study, was to determine whether complete revascularization during index procedure is non inferior vs. staged.
Primary end point was a composite of all-cause mortality, AMI, any unplanned ischemia-driven revascularization, and cerebrovascular events at 1 year.
It included 1525 patients randomized to complete revascularization during index procedure (N= 764) vs. staged within 6 weeks after index procedure (N=761). Mean age was 65. Patients were mostly men. The most frequent form of presentation was non ST elevation ACS.
Read also: ACC 2023 | TAVR in Low Risk Patients: 3-Year Outcomes.
Primary end point resulted lower in the immediate revascularization group with HR: 0·78 (95% CI, 0·55-1·11) p=0·001 for non-inferiority and p=0·166 for superiority, at the expense of a lower rate of AMI (P=0.005) and unplanned ischemia driven revascularization (P=0.030).
Conclusion
In patients with ACS and multivessel disease, immediate complete revascularization resulted non-inferior to staged revascularization, as regards the primary end point, and was also associated to lower AMI and unplanned ischemia driven revascularization at 1 year.
Dr. Andrés Rodríguez.
Member of the Editorial Board of SOLACI.org.
Original Title: Complete Revascularization Strategies in Patients Presenting With Acute Coronary Syndrome and Multivessel Coronary Disease.
Reference: Roberto Diletti MD, PhD et al.
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