Timing of Complete Multivessel Revascularization in Patients Presenting With Non-ST-Segment Elevation Acute Coronary Syndrome

• DOI: 10.1016/j.jcin.2024.01.278
• Publication Date: 2024-03-25T18:46:23Z
• Authors: Jacob J. Elscot; Hala Kakar; Paola Scarparo; Wijnand K. den De...; Johan Bennett; Carl E. Schotborgh; René van der Schaaf; Manel Sabaté; Raúl Moreno; Koen Ameloot; Rutger J. van Bommel; Daniele Forlani; Bert Van Reet; Giovanni Esposito; Maurits T. Dirksen; Willem P.T. Ruifrok; Bert R.C. Everaert; Carlos Van Mieghem; Eduardo Pinar; Fernando Alfonso; Paul Cummins; Mattie Lenzen; Salvatore Brugaletta; Joost Daemen; Eric Boersma; Nicolas M. Van Mi...; Roberto Diletti
• Keywords: Culprit

Complete revascularization of the culprit and all significant nonculprit lesions in patients with non–ST-segment elevation acute coronary syndrome (NSTE-ACS) multivessel disease (MVD) reduces major adverse cardiac events, but optimal timing remains unclear. This study aims to compare immediate complete (ICR) staged (SCR) presenting NSTE-ACS MVD. prespecified substudy BIOVASC (Percutaneous Revascularization Strategies Using Sirolimus Eluting Biodegradable Polymer Coated Stents Patients Presenting With Acute Coronary Syndrome Multivessel Disease) trial included Risk differences primary composite outcome all-cause mortality, myocardial infarction (MI), unplanned ischemia-driven (UIDR), or cerebrovascular events its individual components were compared between ICR SCR at 1 year. The enrolled 1,525 patients; 917 presented NSTE-ACS, whom 459 allocated 458 SCR. Incidences similar 2 groups (7.9% vs 10.1%; risk difference 2.2%; 95% CI: −1.5 6.0; P = 0.15). was associated a reduction MIs (2.0% 5.3%; 3.3%; 0.9 5.7; 0.006), which maintained after exclusion procedure-related occurring during index procedure 4.4%; 2.4%; 0.1 4.7; 0.032). UIDRs also reduced group (4.2% 7.8%; 3.5%; 0.4 6.6; 0.018). is safe MVD