den Dekker Wijnand K, Elscot Jacob J, Bennett Johan, Schotborgh Carl E, van der Schaaf Rene, Sabaté Manel, Moreno Raúl, Ameloot Koen, van Bommel Rutger, Forlani Daniele, van Reet Bert, Esposito Giovanni, Dirksen Maurits T, Ruifrok Willem P T, Everaert Bert R C, Van Mieghem Carlos, Cummins Paul, Lenzen Mattie, Brugaletta Salvatore, Boersma Eric, Van Mieghem Nicolas M, Diletti Roberto
Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands.
Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands.
JACC Cardiovasc Interv. 2024 Dec 23;17(24):2866-2874. doi: 10.1016/j.jcin.2024.09.058.
In patients with acute coronary syndromes (ACS) and multivessel coronary disease, immediate complete revascularization was noninferior to staged complete revascularization for the primary composite outcome at 1 year. The authors report clinical outcomes at 2 years of follow-up.
Patients with ACS and multivessel coronary disease were randomly assigned to immediate complete revascularization or to staged complete revascularization at 29 sites in Europe. The primary outcome was the composite of all-cause mortality, myocardial infarction, any unplanned ischemia-driven revascularization, and cerebrovascular event.
In total, 764 patients were enrolled and randomly allocated to the immediate complete revascularization arm and 761 to the staged complete revascularization arm. Two-year follow-up was complete for 97.6% of patients. At 2 years, the primary outcome had occurred in 12.5% of patients in the immediate complete revascularization group and 12.4% of patients in the staged complete revascularization group (HR: 0.98; 95% CI: 0.73-1.30; P = 0.88). Myocardial infarction occurred more frequently in the staged complete revascularization group (6.2% vs 3.8%; HR: 0.60; 95% CI: 0.37-0.96; P = 0.032). In the immediate complete revascularization and staged complete revascularization groups, the rates of all-cause mortality (3.3% vs 2.0%; HR: 1.67; 95% CI: 0.88-3.16; P = 0.12), any unplanned ischemia-driven revascularization (7.0% vs 7.9%; HR: 0.87; 95% CI: 0.60-1.26; P = 0.57), and cerebrovascular event (2.5% vs 1.7%; HR: 1.39; 95% CI: 0.68-2.83; P = 0.37) were not significantly different.
In patients with ACS and multivessel disease, there was no significant difference between immediate complete revascularization and staged complete revascularization with respect to the composite outcome of all-cause mortality, myocardial infarction, any unplanned ischemia-driven revascularization, and cerebrovascular event at 2 years. Immediate complete revascularization was associated with a significant reduction in myocardial infarction, mainly due to fewer early events. (Direct Complete Versus Staged Complete Revascularization in Patients Presenting With Acute Coronary Syndromes and Multivessel Disease [BioVasc]; NCT03621501).
在急性冠状动脉综合征（ACS）合并多支冠状动脉疾病的患者中，就1年时的主要复合结局而言，即刻完全血运重建不劣于分期完全血运重建。作者报告了2年随访时的临床结局。
欧洲29个地点将ACS合并多支冠状动脉疾病的患者随机分配至即刻完全血运重建组或分期完全血运重建组。主要结局是全因死亡、心肌梗死、任何非计划的缺血驱动的血运重建和脑血管事件的复合结局。
总共764例患者入组并随机分配至即刻完全血运重建组，761例患者分配至分期完全血运重建组。97.6%的患者完成了2年随访。2年时，即刻完全血运重建组12.5%的患者和分期完全血运重建组12.4%的患者发生了主要结局（风险比[HR]：0.98；95%置信区间[CI]：0.73 - 1.30；P = 0.88）。分期完全血运重建组心肌梗死发生率更高（6.2%对3.8%；HR：0.60；95%CI：0.37 - 0.96；P = 0.032）。在即刻完全血运重建组和分期完全血运重建组中，全因死亡率（3.3%对2.0%；HR：1.67；95%CI：0.88 - 3.16；P = 0.12）、任何非计划的缺血驱动的血运重建率（7.0%对7.9%；HR：0.87；95%CI：0.60 - 1.26；P = 0.57）和脑血管事件发生率（2.5%对1.7%；HR：1.39；95%CI：0.68 - 2.83；P = 0.37）无显著差异。
在ACS合并多支血管疾病的患者中，就2年时全因死亡、心肌梗死、任何非计划的缺血驱动的血运重建和脑血管事件的复合结局而言，即刻完全血运重建和分期完全血运重建之间无显著差异。即刻完全血运重建与心肌梗死显著减少相关，主要是由于早期事件较少。（急性冠状动脉综合征合并多支血管疾病患者直接完全血运重建与分期完全血运重建对比研究[BioVasc]；临床试验注册号：NCT03621501）
