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Multivessel vs. culprit-only revascularization in non-ST segment elevation acute coronary syndrome
Session:
Painel 7 - Doença Coronária 8
Speaker:
Cátia Santos Ferreira
Congress:
CPC 2020
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.4 Acute Coronary Syndromes – Treatment
Session Type:
Posters
FP Number:
---
Authors:
Cátia Santos Ferreira; Rui Baptista; André Azul Freitas; James Milner; João André Ferreira; Sofia S. Martinho; José Almeida; Valdirene Gonçalves; Gustavo M. Campos; João Rosa; Sílvia Monteiro; Francisco Gonçalves; Pedro Monteiro; Lino Gonçalves
Abstract
<p>BACKGROUND: In non-ST elevation acute coronary syndrome (NSTE-ACS), the benefits of a strategy based in a complete revascularization (CR) of multivessel disease (MVD) by percutaneous coronary intervention (PCI) besides culprit vessel-only PCI is not clear. We examined the long-term mortality of NSTE-ACS patients with MVD submitted to culprit vessel-only (incomplete revascularization, IR) compared to CR for multivessel PCI.</p> <p>METHODS: After excluding patients with left main disease, single-vessel disease, subjected to CABG or patients with an emergency indication for angiography at admission, we identified 460 NSTE-ACS patients from a database of 3,782 ACS patients consecutively admitted to and discharged alive from a coronary care unit. Outcomes included all-cause mortality at 6 months, 1, and 3 years. A propensity score matching (PSM) methodology was used. Finally, a subgroup analysis focused on predetermined higher risk groups was conducted.</p> <p>RESULTS: CR was performed in 128 (28%) patients. Cardiovascular risk factors prevalence was similar between groups (Table 1). Patients undergoing CR had lower GRACE risk scores, higher systolic blood pressure and left ventricular ejection fraction (LVEF), and less severe anatomic disease (Table 1). Although numerically lower in CR patients, no significant differences were detected in 6-month (0.7 vs 2.2%), 1-year (0.9 vs 4.1%) and 3-year (2-0 vs 7.0%) all-cause mortality, compared to IR patients (Table 2; Figure 1). After PSM with 1:1 matching, again no significant difference on mortality was identified (Figure 2). We also explored the impact of a CR-based strategy in five high-risk subgroups in the original dataset with 460 patients [patients over and under 75 years, LVEF (under 40% vs over 40%), creatinine under vs over 1.5 mg.dL<sup>-1</sup>, presence or not of diabetes mellitus type 2; and type of NSTE-ACS (unstable angina vs non-ST elevation myocardial infarction, NSTEMI)]. A beneficial effect of CR in comparison with IR was detected in NSTEMI patients, regarding 3-year mortality (<em>P</em> for interaction = 0.008) (Table 3, Figure 3).</p> <p>CONCLUSION: In this selected population of NSTE-ACS patients, a multivessel, anatomically-guided CR strategy was not associated with a better long-term survival, compared with a culprit-vessel only strategy. Nonetheless, the NSTEMI subgroup patients seem to benefit more from a CR-based strategy.</p>
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