Effect of Timing of Staged Percutaneous Coronary Intervention on Clinical Outcomes in Patients With Acute Coronary Syndromes

Abstract

Background Complete revascularization reduces cardiovascular events in patients with acute coronary syndromes (ACSs) and multivessel disease. The optimal time point of non–target‐vessel percutaneous coronary intervention (PCI) remains a matter of debate. The aim of this study was to investigate the impact of early (<4 weeks) versus late (≥4 weeks) staged PCI of non–target‐vessels in patients with ACS scheduled for staged PCI after hospital discharge. Methods and Results All patients with ACS undergoing planned staged PCI from 2009 to 2017 at Bern University Hospital, Switzerland, were analyzed. Patients with cardiogenic shock, in‐hospital staged PCI, staged cardiac surgery, and multiple staged PCIs were excluded. The primary end point was all‐cause death, recurrent myocardial infarction and urgent premature non–target‐vessel PCI. Of 8657 patients with ACS, staged revascularization was planned in 1764 patients, of whom 1432 patients fulfilled the eligibility criteria. At 1 year, there were no significant differences in the crude or adjusted rates of the primary end point (7.8% early versus 10.8% late, hazard ratio [HR], 0.72 [95% CI, 0.47–1.10], P =0.129; adjusted HR, 0.80 [95% CI, 0.50–1.28], P =0.346) and its individual components (all‐cause death: 1.5% versus 2.9%, HR, 0.52 [95% CI, 0.20–1.33], P =0.170; adjusted HR, 0.62 [95% CI, 0.23–1.67], P =0.343; recurrent myocardial infarction: 4.2% versus 4.4%, HR, 0.97 [95% CI, 0.475–1.10], P =0.924; adjusted HR, 1.03 [95% CI, 0.53–2.01], P =0.935; non–target‐vessel PCI, 3.9% versus 5.7%, HR, 0.97 [95% CI, 0.53–1.80], P =0.928; adjusted HR, 1.19 [95% CI, 0.61–2.34], P =0.609). Conclusions In this single‐center cohort study of patients with ACS scheduled to undergo staged PCI after hospital discharge, early (<4 weeks) versus late (≥4 weeks) staged PCI was associated with a similar rate of major adverse cardiac events at 1 year follow‐up. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02241291.

Incidence of left ventricular thrombus following STEMI in the modern era via multimodality imaging: A systematic review and meta-analysis

“…Alternatively, the observed funnel plot asymmetry might reflect a volume-outcome relationship, with larger, high-volume centers reporting lower LVT incidence. This could be due to quicker and more effective pPCI provided by larger, more experienced institutions [31] , [32] . Similar observations were made by Robinson et al in their analysis of aSTEMI patients and by Wang et al, who also noted funnel plot asymmetry for this clinical question [4] , [24] .…”

Quantitative Flow Ratio to Predict Non–Target‐Vessel Events Before Planned Staged Percutaneous Coronary Intervention in Patients With Acute Coronary Syndrome

“…Specific clinical inclusion and exclusion criteria for this investigation have been reported previously. 24 In brief, all patients with ACS included in the Cardiobase Bern PCI registry scheduled to undergo single staged PCI between 2009 and 2017 were eligible for this analysis. According to the institutional protocol, patients were mostly scheduled between 2 and 8 weeks from index PCI; however, up to 6 months was allowed.…”

“…According to the institutional protocol, patients were mostly scheduled between 2 and 8 weeks from index PCI; however, up to 6 months was allowed. 24 Patients with in‐hospital staged PCI were excluded, as reported previously, 24 since they usually represent different subsets of patients with either critical lesions requiring urgent intervention or patients who are not willing to return for staged PCI procedures (ie, advanced age or living far away). Patients with cardiogenic shock, multiple staged PCIs, staged cardiac surgery, or missing information on staged PCI were also excluded.…”

“…Patients with cardiogenic shock, multiple staged PCIs, staged cardiac surgery, or missing information on staged PCI were also excluded. 24 …”

“…Staged procedures were usually performed between 2 and 8 weeks following index PCI according to institutional practice, but the exact timing was left to the operators' discretion. 24 It cannot be excluded that patient‐ or lesion‐related factors may have played a role in the scheduling. Therefore, this study aimed at investigating the potential value of QFR on top of clinical judgment.…”