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Optimal Revascularization Strategy in Non-ST-Segment-Elevation Myocardial Infarction With Multivessel Coronary Artery Disease: Culprit-Only Versus One-Stage Versus Multistage Revascularization

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Author(s)
Min Chul KimJu Yong HyunYoungkeun AhnSungA BaeDae Young HyunKyung Hoon ChoDoo Sun SimYoung Joon HongJu Han KimMyung Ho JeongHyo‐Soo KimHyeon Cheol GwonIn Whan SeongKyoung‐Kook HwangShung Chull ChaeSeung Ho HurKwang Soo ChaSeok Kyu Oh
Keimyung Author(s)
Hur, Seung Ho
Department
Dept. of Internal Medicine (내과학)
Journal Title
Journal of the American Heart Association
Issued Date
2020
Volume
9
Issue
15
Keyword
multivessel coronary artery diseasemyocardial infarctionpercutaneous coronary
Abstract
Background:
Few studies have investigated optimal revascularization strategies in non–ST‐segment–elevation myocardial infarction with multivessel disease. We investigated 3‐year clinical outcomes according to revascularization strategy in patients with non–ST‐segment–elevation myocardial infarction and multivessel disease.

Methods and Results:
This retrospective, observational, multicenter study included patients with non–ST‐segment–elevation myocardial infarction and multivessel disease without cardiogenic shock. Data were analyzed at 3 years according to the percutaneous coronary intervention strategy: culprit‐only revascularization (COR), 1‐stage multivessel revascularization (MVR), and multistage MVR. The primary outcome was major adverse cardiac events (MACE: a composite of all‐cause death, nonfatal spontaneous myocardial infarction, or any repeat revascularization). The COR group had a higher risk of MACE than those involving other strategies (COR versus 1‐stage MVR; hazard ratio, 0.65; 95% CI, 0.54–0.77; P<0.001; and COR versus multistage MVR; hazard ratio, 0.74; 95% CI, 0.57–0.97; P=0.027). There was no significant difference in the incidence of MACE between 1‐stage and multistage MVR (hazard ratio, 1.14; 95% CI, 0.86–1.51; P=0.355). The results were consistent after multivariate regression, propensity score matching, inverse probability weighting, and Bayesian proportional hazards modeling. In subgroup analyses stratified by the Global Registry of Acute Coronary Events score, 1‐stage MVR lowered the risk of MACE compared with multistage MVR in low‐to‐intermediate risk patients but not in patients at high risk.

Conclusions:
MVR reduced 3‐year MACE in patients with non–ST‐segment–elevation myocardial infarction and multivessel disease compared with COR. However, 1‐stage MVR was not superior to multistage MVR for reducing MACE except in low‐to‐intermediate risk patients.
Keimyung Author(s)(Kor)
허승호
Publisher
School of Medicine (의과대학)
Citation
Min Chul Kim et al. (2020). Optimal Revascularization Strategy in Non-ST-Segment-Elevation Myocardial Infarction With Multivessel Coronary Artery Disease: Culprit-Only Versus One-Stage Versus Multistage Revascularization. Journal of the American Heart Association, 9(15), e016575. doi: 10.1161/JAHA.120.016575
Type
Article
ISSN
2047-9980
Source
https://www.ahajournals.org/doi/10.1161/JAHA.120.016818
DOI
10.1161/JAHA.120.016575
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/43126
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
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