Staged versus One-Time Percutaneous Coronary Intervention Strategy for Multivessel Non-ST Segment Elevation Acute Coronary Syndrome

Refer to the page 774-783 Patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS) often have multiple non-culprit lesions in addition to culprit lesion. Previous studies suggest that performing " one-time " interventions to non-culprit lesions of multivessel NSTE-ACS patients improve clinical outcomes as compared to culprit-only intervention. 3)4) Shishehbor et al. 3) reported that multivessel percutaneous coronary intervention (PCI) strategy reduces composite endpoint of all-cause death, myocardial infarction (MI), and revascularization (hazard ratio [HR] 0.67, 95% confidence interval [CI] 0.51-0.88, p=0.004) compared to culprit only PCI strategy. Most of the benefits were driven by reduction in revascularization (HR 0.59, 95% CI 0.41–0.84, p=0.003) and there was no statistically significant difference in the rate of death or composite of death and MI. In the study reported by Kim et al., 4) multivessel PCI strategy reduced major adverse cardiovascular events (a composite of all-causes deaths, myocardial infarction, repeated revascularization, and coronary artery bypass grafting) compared to culprit only, staged PCI strategy. There are 2 strategies to perform PCI in NSTE-ACS patients with multivessel disease: staged PCI and " one-time " PCI. Although multivessel PCI is considered to be a reasonable approach in NSTE-ACS patients with significant multivessel lesions, 3)4) whether to undergo staged PCI or to perform one-time PCI in such patients is an area of active debate. The study performed by Yu et al. 5) attempts to provide an answer to this important issue in the field of interventional cardiology. Principal findings of the study This study performed by Yu et al. 5) raises the hypothesis that staged PCI for intermediate to very high risk multivessel NSTE-ACS patients offers a better clinical results as compared to one-time PCI strategy in terms of cardiac death and MI. More than 1500 consecutive intermediate to very high risk multivessel NSTE-ACS patients were analyzed. Staged PCI was performed in 672 patients and one-time PCI in 859 patients. The primary endpoint was a composite of 3-year cardiac death, MI, and target vessel revascularization (TVR). Because of the inherent nature of non-randomized study, the baseline clinical and angiographic characteristics of the 2 groups were significantly different with unfavorable clinical and angiographic characteristics in the staged PCI group. The staged PCI group had a higher rate of previous MI, current-smoker, and 3 vessel disease. Stent numbers and total stent length per patient were significantly higher, and complete revascularization rate was significantly lower in the staged PCI group. …