Multivessel intervention trumps culprit vessel-only revascularization for NSTE-ACS
Multivessel revascularization (MVR) is better than culprit vessel-only revascularization (CVR) in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS), reports a recent meta-analysis.
Accessing the databases of PubMed and Embase, researchers identified 15 eligible studies, yielding a pooled sample of 171,279 patients. Of these, majority (n=113,004) underwent CVR while the remaining 58,275 received MVR. Thirteen of the included studies were retrospective in design, while the other two were posthoc analyses of randomized controlled trials.
In the short-term MVR was correlated with a significantly higher prevalence of major adverse cardiovascular events (MACEs; odds ratio [OR], 1.14, 95 percent confidence interval [CI], 1.01–1.29) and a lower likelihood of coronary artery bypass grafting (OR, 0.35, 95 percent CI, 0.29–0.43).
There were no between-intervention differences in terms of all-cause death, myocardial infarction or repeat percutaneous coronary intervention.
Over long-term follow-ups, defined as >6 months after the index procedure, those who received MVR vs CVR were significantly less likely to experience a MACE event (OR, 0.76, 95 percent CI, 0.61–0.93). Similarly, the need to undergo repeat revascularization was significantly lower in the MVR group (OR, 0.62, 95 percent CI, 0.42–0.90), as was the risk of all-cause mortality (OR, 0.83, 95 percent CI, 0.71–0.97).
“There is a high prevalence of multivessel disease in patients who present with NSTE-ACS, and with burgeoning technologies and risk stratification tools, randomized controlled trials are needed,” said researchers.