Can Timing of Nontarget-vessel PCI Impact Patients with ACS & Multivessel Disease ?
Multivessel disease (MVD) among patients with acute coronary syndromes (ACSs) is associated with impaired prognosis. However, the optimal time point of non-culprit‐lesion revascularization remains a matter of ongoing debate.
A recent study suggests that the timing of nontarget-vessel percutaneous coronary intervention (PCI) appears not to have a strong effect on major adverse cardiac events in patients with multivessel coronary artery disease who have had an acute coronary syndrome (ACS).
The study findings were published in the Journal of the American Heart Association on November 24, 2021.
Complete revascularization reduces cardiovascular events in patients with ACSs and multivessel disease. Evidence on comparing different time intervals of staged PCI among patients with ACS is limited. Therefore, Dr Lorenz Räber and his team conducted a study to investigate the impact of early (<4 weeks) versus late (≥4 weeks) staged PCI of non–target‐vessels in patients with ACS scheduled for staged PCI after hospital discharge.
In this cohort study of a large prospective registry of post-ACS, the researchers included a total of 1432 patients who underwent planned PCI (2009-2017). They evaluated the all‐cause death, recurrent myocardial infarction and urgent premature non–target‐vessel PCI.
Key findings of the study:
♦ After a year, the researchers found no significant differences in the crude or adjusted rates of the primary endpoint in early versus late PCI. (7.8% early versus 10.8% late, hazard ratio [HR], 0.72; adjusted HR, 0.80).
♦ Individual components were:
- All‐cause death: 1.5% versus 2.9%, HR, 0.52; adjusted HR, 0.62.
- Recurrent myocardial infarction: 4.2% versus 4.4%, HR, 0.97; adjusted HR, 1.03.
- Non–target‐vessel PCI, 3.9% versus 5.7%, HR, 0.97; adjusted HR, 1.19.
The authors concluded, "In patients with both ACS and MVD scheduled to undergo staged PCI after hospital discharge, early (<4 weeks) compared with late staged PCI (≥4 weeks) was associated with a similar rate of the primary endpoint all‐cause death, recurrent MI, urgent premature non–target‐vessel PCI in this single-centre and all‐comer population."
For further information:
DOI: https://doi.org/10.1161/JAHA.121.023129
