Author + information
- Received December 6, 2019
- Revision received February 25, 2020
- Accepted April 14, 2020
- Published online July 6, 2020.
- Kevin R. Bainey, MD, MSca,b,c,∗ (, )
- Wendimagegn Alemayehu, PhDa,
- Paul W. Armstrong, MDa,b,
- Cynthia M. Westerhout, PhDa,
- Padma Kaul, PhDa,b and
- Robert C. Welsh, MDa,b,c
- aCanadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada
- bDivision of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
- cMazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
- ↵∗Address for correspondence:
Dr. Kevin R. Bainey, University of Alberta Hospital, 2C2.12 WMC, 8440 112 Street, Edmonton, Alberta T6G 2B7, Canada.
Objectives The aim of this study was to evaluate the long-term outcomes of patients with acute coronary syndromes (ACS) with multivessel disease undergoing percutaneous coronary intervention (PCI).
Background Controversy exists regarding the benefit of multivessel PCI across the spectrum of ACS.
Methods A total of 9,094 patients with ACS and multivessel disease (≥70% stenosis in 2 or more major epicardial vessels) undergoing PCI from the Alberta COAPT (Contemporary Acute Coronary Syndrome Patients Invasive Treatment Strategies) registry (April 1, 2007, to March 31, 2013) were reviewed. Comparisons were made between patients who underwent complete revascularization and those with incomplete revascularization. Complete revascularization was defined as multivessel PCI with a residual angiographic jeopardy score ≤10%. Associations between revascularization status and all-cause death or new myocardial infarction (primary composite endpoint) and all-cause death, new myocardial infarction, or repeat revascularization (secondary composite endpoint) were evaluated.
Results Of the study cohort, 66.0% underwent complete revascularization. Compared with incomplete revascularization, the primary composite endpoint occurred less frequently with complete revascularization (event rate within 5 years 15.4% vs. 22.2%; inverse probability-weighted hazard ratio [IPW-HR]: 0.78; 95% confidence interval [CI]: 0.73 to 0.84; p < 0.0001). The secondary composite endpoint was less likely to occur with complete revascularization (event rate within 5 years 23.3% vs. 37.5%; IPW-HR: 0.61; 95% CI: 0.58 to 0.65; p < 0.0001). Complete revascularization was associated with a reduction in all-cause death (IPW-HR: 0.79; 95% CI: 0.73 to 0.86; p = 0.0004), new myocardial infarction (IPW-HR: 0.76; 95% CI: 0.69 to 0.84; p < 0.0001), and repeat revascularization (IPW-HR: 0.53; 95% CI: 0.49 to 0.57; p < 0.0001).
Conclusions Results from this large contemporary registry of patients with ACS and PCI for multivessel disease suggest that complete revascularization occurs commonly and is associated with improved clinical outcomes (including survival) within 5 years.
- acute coronary syndromes
- complete revascularization
- multivessel disease
- percutaneous coronary intervention
Dr. Bainey has received personal and research support from AstraZeneca, Bayer, Boehringer Ingelheim and Pfizer/Bristol-Myers Squibb. Dr. Armstrong has received grant support from Sanofi Aventis Research and Development, Boehringer Ingelheim, and CSL; and has received consulting fees from AstraZeneca and Novartis. Dr. Welsh has received personal and research support from AstraZeneca, Bayer, Boehringer Ingelheim, and Pfizer/Bristol-Myers Squibb. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Cardiovascular Interventions author instructions page.
- Received December 6, 2019.
- Revision received February 25, 2020.
- Accepted April 14, 2020.
- 2020 American College of Cardiology Foundation
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