Immediate versus staged complete revascularization in patients presenting with multivessel disease and ST- or non-ST-segment elevation acute coronary syndrome

IF 3.2 2区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

International journal of cardiology Pub Date : 2025-06-16 DOI:10.1016/j.ijcard.2025.133496

Jacob J. Elscot , Hala Kakar , Wijnand K. den Dekker , Johan Bennett , Manel Sabaté , Giovanni Esposito , Eric Boersma , Eugene McFadden , Hector M. Garcia-Garcia , Nicolas M. Van Mieghem , Roberto Diletti , on behalf of the BIOVASC investigators

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引用次数: 0

Abstract

Background

Recent randomized trials have suggested that immediate complete revascularization (ICR) is a viable alternative to staged complete revascularization (SCR) in patients with acute coronary syndrome (ACS) and multivessel disease. However, long-term outcomes comparing ICR with SCR in ST-segment elevation (STE) and non-ST-segment elevation (NSTE) ACS remain unclear.

Methods

This study analyzes 2-year follow-up data from the BIOVASC trial, randomizing ACS patients to ICR or SCR. The primary composite endpoint includes all-cause mortality, myocardial infarction, unplanned ischemia-driven revascularization, and cerebrovascular events. Secondary endpoints evaluate these outcomes individually. Cox regression assessed if STE/NSTE-ACS diagnosis influences treatment effect.

Results

In 608 STE-ACS patients, the 2-year cumulative incidence of the primary composite endpoint was 10.9 % (ICR) and 11.7 % (SCR) (risk difference [RD] 0.8 %, 95 % confidence interval [CI] -4.3 % to 5.9 %; P = 0.71). In NSTE-ACS, cumulative incidence was 13.5 % (ICR) and 12.8 % (SCR) (RD −0.7 %, 95 % CI -5.1 % to 3.7 %; P = 0.90). No differential effect was observed comparing ICR with SCR between STE- and NSTE-ACS.

Conclusions

ICR did not sustain a significant benefit in terms of the primary and secondary outcomes at 2 years follow-up. In addition, no differential effect of ICR versus SCR was observed between STE-ACS and NSTE-ACS after 2 years follow-up. However, there seems to be a late catch-up in the cumulative event rate in patients randomized to ICR.

查看原文本刊更多论文

多血管疾病和ST段或非ST段抬高急性冠状动脉综合征患者的立即与分期完全血运重建术

背景：最近的随机试验表明，在急性冠脉综合征（ACS）和多血管疾病患者中，立即完全血运重建术（ICR）是分期完全血运重建术（SCR）的可行替代方案。然而，比较ICR和SCR在st段抬高（STE）和非st段抬高（NSTE） ACS中的长期结果仍不清楚。方法：本研究分析了BIOVASC试验的2年随访数据，将ACS患者随机分为ICR或SCR。主要综合终点包括全因死亡率、心肌梗死、计划外缺血驱动的血运重建和脑血管事件。次要终点分别评价这些结果。Cox回归评估STE/NSTE-ACS诊断是否影响治疗效果。结果：608例STE-ACS患者中，主要复合终点的2年累积发病率为10.9 % （ICR）和11.7 % (SCR)(风险差[RD] 0.8 %，95 %可信区间[CI] -4.3 % ~ 5.9 %； = 0.71页)。在NSTE-ACS中，累积发病率为13.5 % （ICR）和12.8 % (SCR) (RD -0.7 %,95 % CI -5.1 %至3.7 %； = 0.90页)。在STE-和NSTE-ACS之间比较ICR和SCR无差异。结论：在2 年的随访中，ICR在主要和次要结局方面没有维持显著的获益。此外，经过2 年的随访，STE-ACS和NSTE-ACS之间没有观察到ICR和SCR的差异。然而，随机分配到ICR的患者的累积事件发生率似乎有一个较晚的追赶。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International journal of cardiology 医学-心血管系统

CiteScore

6.80

自引率

5.70%

发文量

758

审稿时长

44 days

期刊介绍： The International Journal of Cardiology is devoted to cardiology in the broadest sense. Both basic research and clinical papers can be submitted. The journal serves the interest of both practicing clinicians and researchers. In addition to original papers, we are launching a range of new manuscript types, including Consensus and Position Papers, Systematic Reviews, Meta-analyses, and Short communications. Case reports are no longer acceptable. Controversial techniques, issues on health policy and social medicine are discussed and serve as useful tools for encouraging debate.