"Revascularization Strategies for Multivessel Disease in Acute Coronary" by Khaled M. Harmouch, Mohammad Hamza et al.
 

Revascularization Strategies for Multivessel Disease in Acute Coronary Syndrome: Network Meta-analysis

Khaled M. Harmouch, Department of Internal Medicine, Wayne State University School of Medicine, Detroit Medical Center, Detroit, Michigan.
Mohammad Hamza, Department of Internal Medicine, Guthrie Medical Group, New York, New York.
Nomesh Kumar, Department of Internal Medicine, Wayne State University School of Medicine, Detroit Medical Center, Detroit, Michigan.
Zarghoona Wajid, Department of Internal Medicine, Wayne State University School of Medicine, Ascension Providence Rochester Hospital, Rochester, Michigan.
Neel Patel, Department of Internal Medicine, New York Medical College, Valhalla, New York.
Masooma Naseem, Department of Internal Medicine, Louisiana State University Health Shreveport, Shreveport, Louisiana.
Jawad Basit, Department of Medicine, Rawalpindi Medical University, Rawalpindi, Pakistan.
Prakash Upreti, Rochester Regional HealthFollow
Manoj Kumar, Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois.
Waqas Ullah, Department of Cardiology, Thomas Jefferson University, Philadelphia, Pennsylvania.
Yasar Sattar, Department of Cardiology, West Virginia University, Morgantown, West Virginia.
Timir K. Paul, Cardiovascular Institute, Saint Thomas Heart Institute, University of Tennessee Health Sciences Center, Nashville, Tennessee.
Emmanouil Brilakis, Department of Interventional Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota.
M Chadi Alraies, Cardiovascular Institute, Detroit Medical Center, Wayne State University, Detroit, Michigan.

Department

Medicine

Document Type

Article

Publication Title

Journal of the Society for Cardiovascular Angiography & Interventions

Abstract

Background: The optimal revascularization strategy for patients with acute coronary syndrome (ACS) and multivessel disease (MVD) remains debated. This study compares the efficacy and safety of different revascularization strategies in these patients.

Methods: We included 20 studies comparing staged, complete, and culprit-only (CO) revascularization strategies in patients with ACS and MVD. We divided the revascularization strategies into 3 distinct strategies: CO, complete index procedure (CIP), and complete staged procedure (CSP). We then compared CIP and CSP with CO. Outcomes studied are all-cause mortality, cardiac death, recurrent myocardial infarction (MI), need for revascularization, bleeding, contrast-induced nephropathy (CIN), stroke, bleeding, and stent thrombosis.

Results: Compared with the CO group, both the CIP group (relative risk [RR], 0.42; 95% CI, 0.26-0.69; P < .001) and the CSP group (RR, 0.53; 95% CI, 0.35-0.82; P < .001) showed a lower need for revascularization. The CSP group had a lower incidence of cardiac death (RR, 0.67; 95% CI, 0.48-0.94; P = .02). The CIP group experienced fewer recurrent MI (RR, 0.58; 95% CI, 0.35-0.94; P = .03). There was no statistically significant difference in all-cause mortality, bleeding, CIN, stroke, or stent thrombosis between the CIP group and the CSP group compared with the CO group.

Conclusions: Our findings support complete revascularization (CIP or CSP) over CO for patients with ACS and MVD. Both CIP and CSP are associated with lower needs for future revascularization. CSP was associated with lower cardiac deaths. CIP was associated with fewer recurrent MI. Additionally, both strategies were safe with no differences noted in bleeding, CIN, stroke, and stent thrombosis.

First Page

102449

DOI

10.1016/j.jscai.2024.102449

Volume

4

Issue

1

Publication Date

1-1-2025

PubMed ID

40061411

Link to Full Text

Share

COinS