In Unstable Angina or Non–ST-Segment Acute Coronary Syndrome, Should Patients With Multivessel Coronary Artery Disease Undergo Multivessel or Culprit-Only Stenting?

Abstract

In patients with multivessel CAD presenting with NSTE-ACS, multivessel intervention was significantly associated with a lower revascularization rate, which translated to a lower incidence of the composite end point compared with culprit-only stenting.

Multivessel vs Single‐Vessel Revascularization in Patients With Non–ST‐Segment Elevation Acute Coronary Syndrome and Multivessel Disease in the Drug‐Eluting Stent Era

“…6 However, few studies have compared outcomes of MVR and SVR in these patients undergoing PCI. 7,8,12 Results from previous studies are controversial. Moreover, these studies were conducted before the introduction of DES and cannot reflect current practice.…”

“…These results were consistent with the results from previous studies with bare-metal stents on the same topic. 7,8 Because selection of treatment strategy is apt to be strongly affected by jeopardized myocardial territory and lesion complexity, we investigated whether the benefit of MVR might differ according to the APPROACH lesion score and the SYNTAX score. Although the SYNTAX score did not affect treatment strategy, the APPROACH lesion score was associated with the performance of MVR.…”

“…Multivessel disease was defined as coronary lesions with ≥50%-diameter stenosis by quantitative coronary analysis in at least 2 of the 3 major epicardial coronary arteries or their major branches. 7 Patients who had prior coronary bypass grafts, isolated left main coronary artery disease (CAD), or chronic total occlusions; who had experienced cardiogenic shock before intervention; and who underwent planned staged intervention after discharge from the index hospitalization were excluded. After the exclusions, the study population for the analysis included 366 patients.…”

“…Few studies have compared long-term outcomes of multivessel revascularization (MVR) and single-vessel revascularization (SVR) in patients with NSTE-ACS and MVD undergoing PCI. 7,8 Moreover, these studies were conducted in the era of bare-metal stents. Therefore, we sought to compare longterm outcomes for MVR vs SVR using drug-eluting stents (DES) in patients with NSTE-ACS and MVD.…”

Staging of multivessel percutaneous coronary interventions: An expert consensus statement from the Society for Cardiovascular Angiography and Interventions

“…CR is relevant to the extent that CR improves clinical outcomes. However, the clinical benefits of CR using angiographic criteria are uncertain, with some [65,[67][68][69][70] but not all [71][72][73] studies reporting superior outcomes with CR. CR does reduce the incidence of subsequent CABG [66,74] or subsequent PCI [64] (Table II).…”