Impact of Complete Revascularization Strategies on the Clinical Outcomes of Patients With Non-ST-Segment Elevation Myocardial Infarction and Multivessel Disease: Multicentre Real-World Evidence From China.

BACKGROUND

The prognostic impact of complete revascularization in patients with non-ST-segment elevation myocardial infarction (NSTEMI) and multivessel disease (MVD) remains uncertain.

AIMS

This study aimed to compare clinical outcomes between complete and incomplete revascularization in NSTEMI patients with MVD, assessing the optimal timing and strategy for revascularization.

METHODS

We analyzed 2460 consecutive NSTEMI patients with MVD enrolled across five institutions between January 2021 and December 2022. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCEs: all-cause death, recurrent myocardial infarction, heart failure, stroke, and urgent revascularization) and major adverse cardiac events (MACEs: cardiovascular death, recurrent myocardial infarction, heart failure, and urgent revascularization). Multivariable Cox proportional hazards regression analysis was conducted to adjust for important clinical characteristics, and adjusted hazard ratio (aHR) with a 95% confidence interval (CI) was calculated to assess the risk of clinical outcomes. Inverse probability weighting analysis was performed to verify the robustness of the results.

RESULTS

Over a median 528-day follow-up, complete revascularization was associated with a significantly lower risk of MACCEs (aHR 0.48, 95% CI 0.36-0.64) and MACEs (aHR 0.45, 95% CI 0.33-0.60) compared to incomplete revascularization. Single-stage and multistage complete revascularization showed comparable outcomes (MACCEs: aHR 0.93, 95% CI 0.47-1.85; MACEs: aHR 0.89, 95% CI 0.44-1.82). However, compared to delayed multistage complete revascularization, early multistage complete revascularization significantly reduced the risk of MACCEs (aHR 0.05, 95% CI 0.01-0.28) and MACEs (aHR 0.03, 95% CI 0.01-0.27). These results were consistent after confounder adjustment by inverse probability weighting analysis.

CONCLUSION

Complete revascularization is an effective treatment strategy for reducing the risk of adverse clinical outcomes in NSTEMI patients with MVD. Moreover, an early multistage complete revascularization may be a better option.