Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands.
Department of Cardiovascular Medicine, University Hospital Leuven, Leuven, Belgium.
JACC Cardiovasc Interv. 2024 Mar 25;17(6):771-782. doi: 10.1016/j.jcin.2024.01.278.
Complete revascularization of the culprit and all significant nonculprit lesions in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and multivessel disease (MVD) reduces major adverse cardiac events, but optimal timing of revascularization remains unclear.
This study aims to compare immediate complete revascularization (ICR) and staged complete revascularization (SCR) in patients presenting with NSTE-ACS and MVD.
This prespecified substudy of the BIOVASC (Percutaneous Complete Revascularization Strategies Using Sirolimus Eluting Biodegradable Polymer Coated Stents in Patients Presenting With Acute Coronary Syndrome and Multivessel Disease) trial included patients with NSTE-ACS and MVD. Risk differences of the primary composite outcome of all-cause mortality, myocardial infarction (MI), unplanned ischemia-driven revascularization (UIDR), or cerebrovascular events and its individual components were compared between ICR and SCR at 1 year.
The BIOVASC trial enrolled 1,525 patients; 917 patients presented with NSTE-ACS, of whom 459 were allocated to ICR and 458 to SCR. Incidences of the primary composite outcome were similar in the 2 groups (7.9% vs 10.1%; risk difference 2.2%; 95% CI: -1.5 to 6.0; P = 0.15). ICR was associated with a significant reduction of MIs (2.0% vs 5.3%; risk difference 3.3%; 95% CI: 0.9 to 5.7; P = 0.006), which was maintained after exclusion of procedure-related MIs occurring during the index or staged procedure (2.0% vs 4.4%; risk difference 2.4%; 95% CI: 0.1 to 4.7; P = 0.032). UIDRs were also reduced in the ICR group (4.2% vs 7.8%; risk difference 3.5%; 95% CI: 0.4 to 6.6; P = 0.018).
ICR is safe in patients with NSTE-ACS and MVD and was associated with a reduction in MIs and UIDRs at 1 year.
非 ST 段抬高型急性冠状动脉综合征（NSTE-ACS）和多血管疾病（MVD）患者罪犯病变和所有重要非罪犯病变的完全血运重建可降低主要不良心脏事件，但血运重建的最佳时机仍不清楚。
本研究旨在比较非 ST 段抬高型急性冠状动脉综合征（NSTE-ACS）和多血管疾病（MVD）患者的即刻完全血运重建（ICR）和分期完全血运重建（SCR）。
该研究是 BIOVASC 试验的一个预设亚研究，纳入了 NSTE-ACS 和 MVD 患者。比较 1 年时 ICR 和 SCR 两组患者全因死亡率、心肌梗死（MI）、非计划性缺血驱动血运重建（UIDR）或脑血管事件及其各组成部分的主要复合终点风险差异。
BIOVASC 试验共纳入 1525 例患者；917 例患者表现为 NSTE-ACS，其中 459 例被分配至 ICR 组，458 例被分配至 SCR 组。两组患者的主要复合终点发生率相似（7.9% vs 10.1%；风险差异 2.2%；95%CI：-1.5 至 6.0；P=0.15）。ICR 与 MI 发生率显著降低相关（2.0% vs 5.3%；风险差异 3.3%；95%CI：0.9 至 5.7；P=0.006），在排除指数或分期血运重建过程中发生的与操作相关的 MI 后，该结果仍具有统计学意义（2.0% vs 4.4%；风险差异 2.4%；95%CI：0.1 至 4.7；P=0.032）。ICR 组 UIDR 也有所降低（4.2% vs 7.8%；风险差异 3.5%；95%CI：0.4 至 6.6；P=0.018）。
在 NSTE-ACS 和 MVD 患者中，ICR 是安全的，且在 1 年时与 MI 和 UIDR 降低相关。
