Immediate or staged complete revascularisation in patients presenting with acute coronary syndrome by number of diseased vessels: a substudy of the BIOVASC randomised trial.

Autor: Kakar H; Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands., Elscot JJ; Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands., Scarparo P; Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands., Den Dekker WK; Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands., Bennett J; Department of Cardiovascular Medicine, University Hospital Leuven, Leuven, Belgium., Sabaté M; Interventional Cardiology Department, Hospital Clinic, Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain., Esposito G; Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy., Amat-Santos I; Cardiology Department, Hospital Clínico de Valladolid, Valladolid, Spain., Boersma E; Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands., Van Mieghem NM; Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands., Diletti R; Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands.
Jazyk: angličtina
Zdroj: EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology [EuroIntervention] 2024 Apr 15; Vol. 20 (8), pp. e479-e486. Date of Electronic Publication: 2024 Apr 15.
DOI: 10.4244/EIJ-D-23-00762
Abstrakt: Background: In patients presenting with acute coronary syndrome (ACS), the number of diseased vessels may affect the efficacy of a complete revascularisation strategy.
Aims: The authors sought to evaluate the safety and efficacy of immediate complete revascularisation (ICR) and staged complete revascularisation (SCR) in patients presenting with ACS stratified by the number of diseased vessels.
Methods: In this prespecified analysis of the BIOVASC trial, ICR was compared with SCR in patients with two-vessel disease (2VD) or three-vessel disease (3VD). The primary endpoint was a composite of all-cause mortality, myocardial infarction (MI), any unplanned ischaemia-driven revascularisation or cerebrovascular events at 1 year after the index procedure. Comparisons were performed using Cox regression.
Results: A total of 1,525 patients were enrolled in the BIOVASC trial, of whom 1,177 presented with 2VD and 265 with 3VD. In the 2VD group, 613 patients were assigned to ICR and 564 to SCR. In the 3VD group, 117 patients were assigned to ICR and 148 to SCR. ICR and SCR led to similar results in both the 2VD (hazard ratio [HR] 0.76, 95% confidence interval [CI]: 0.50-1.13; p=0.18) and 3VD groups (HR 0.79, 95% CI: 0.39-1.59; p=0.51) (p interaction =0.91) in terms of the primary endpoint. ICR was associated with a lower rate of MI in patients with 3VD (HR 0.21, 95% CI: 0.046-0.93; p=0.04) (p interaction =0.30).
Conclusions: ICR might be an option in patients presenting with extensive 3VD and might be associated with a lower rate of myocardial infarction compared with SCR.
Databáze: MEDLINE
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