Comparison of Stenting and Surgical Revascularization Strategy in Non-ST Elevation Acute Coronary Syndromes and Complex Coronary Artery Disease (from the Milestone Registry)

Long-term outcomes of patients with multivessel coronary artery disease presenting non-ST-segment elevation acute coronary syndromes

“…A similar correlation demonstrating comparable efficacy of PCI and CABG in NSTE-ACS has been demonstrated in the issue of unprotected LM coronary artery [32,33], a proximal segment of LAD [34] and in patients with multivessel CAD and diabetes mellitus [35]. On the other hand, in the MILESTONE Registry, immediate PCI was associated with lower long-term mortality risk compared with surgical revascularization, especially in subgroups at high clinical risk [26]. Importantly in the present study, after adjusting for factors from baseline and angiographic characteristics, the performance of PCI was an independent predictor of improved prognosis in 24-month follow-up.…”

“…In subanalysis of ACUITY trial, designed to compare two methods of revascularization in multivessel CAD, patients undergoing PCI accounted for 78%, while CABG group consisted of 22% of study population [14]. Also, in other studies PCI was the most common method of treatment for multivessel CAD in NSTE-ACS [24][25][26]28]. Early and long-term outcomes in the present analysis have shown that patients treated conservatively after coronary angiography are characterized by the worst prognosis.…”

“…In NSTE-ACS population, except for one single-center trial comparing an optimal timing of staged multivessel intervention [13], to date no prospective randomized clinical trial has been conducted to evaluate the treatment modality of multivessel CAD. Moreover, there is only a limited number of data obtained from one subanalysis of randomized trial and few retrospective studies [11,12,14,[24][25][26]. The optimal treatment method in overall as well as in particular subgroups of patients with NSTE-ACS is unclear.…”

Invited Commentary

“…This information correlates with studies demonstrating surgical advantage with increasing baseline coronary risk, such as severe multivessel disease [3,4], diabetes [5], and left ventricular dysfunction [6]; now we can add advanced age. PCI may be more appropriate for less serious coronary obstruction and for subgroups of patients with higher surgical risk, such as acute coronary syndromes [7], reoperations, and serious comorbidities. Optimizing the transition point from PCI to CABG can reduce periprocedural mortality while enhancing late patient outcomes.…”

Clinical Outcomes after Triple Vessel Angioplasty in Diabetic Patients with Triple Vessel Coronary Artery Disease

“…3,4,5,6,7,8,9,10 Optimal approach for treating multivessel coronary disease has been controversial 11 and triple vessel stenosis in diabetic patients make the matter worse. Though coronary artery bypass surgery (CABG) had been the conventional treatment for triple vessel disease, 12,13,14 due to presence of some limitations like angiographic features related to the extent, location, and nature of CAD, as well as geographic, demographic and clinical factors; preference of approach shifts to percutaneous coronary intervention (PCI) instead of CABG. 15 In addition, some patients have been poor candidates for CABG, like those with disease in distal vessel, severe systemic illness, severe left ventricular dysfunction and previous bypass surgeries.…”