title: Multivessel vs single-vessel revascularization in patients with non-ST-segment elevation acute coronary syndrome and multivessel disease in the drug-eluting stent era.
abstract: BACKGROUND
  We sought to compare long-term outcomes for multivessel revascularization (MVR) vs single-vessel revascularization (SVR) with drug-eluting stents (DES) in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and multivessel coronary artery disease (MVD).
  
  
  OBJECTIVE
  In DES era, MVR would improve long-term clinical outcomes in patients with NSTE-ACS.
  
  
  METHODS
  We studied 179 patients undergoing MVR and 187 patients undergoing SVR for NSTE-ACS and MVD. Major adverse cardiac events (MACE) were defined as death, myocardial infarction, or any revascularization.
  
  
  RESULTS
  During follow-up (median 36 months), MACE occurred in 96 patients (26.2%); 35 (19.6%) in the MVR group and 61 (32.6%) in the SVR group (P=0.003). In multivariate analysis, MVR was associated with a lower incidence of MACE (hazard ratio [HR]: 0.50, 95% confidence interval [CI]: 0.30-0.85) and revascularization (HR: 0.43, 95% CI: 0.24-0.78), but not of death (HR: 0.69, 95% CI: 0.25-1.93) and myocardial infarction (HR: 0.39, 95% CI: 0.11-1.47). The incidence of periprocedural renal dysfunction was not significantly different between patients undergoing MVR vs SVR (3.4% vs 1.6%, P=0.33). Definite or probable stent thrombosis occurred at a similar rate (2.2% in the MVR group and 2.7% in the SVR group, P=0.99).
  
  
  CONCLUSIONS
  In patients with NSTE-ACS and MVD, MVR using drug-eluting stents may reduce MACE. Our findings should be confirmed by a prospective, randomized trial.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Hyun Jong
authors.initials: HJ
authors.lastname: Lee
authors.forename: Young Bin
authors.initials: YB
authors.lastname: Song
authors.forename: Joo-Yong
authors.initials: JY
authors.lastname: Hahn
authors.forename: Sang Min
authors.initials: SM
authors.lastname: Kim
authors.forename: Ji Hyun
authors.initials: JH
authors.lastname: Yang
authors.forename: Joon Hyouk
authors.initials: JH
authors.lastname: Choi
authors.forename: Seung-Hyuk
authors.initials: SH
authors.lastname: Choi
authors.forename: Jin-Ho
authors.initials: JH
authors.lastname: Choi
authors.forename: Sang Hoon
authors.initials: SH
authors.lastname: Lee
authors.forename: Hyeon-Cheol
authors.initials: HC
authors.lastname: Gwon
mesh_terms: D054058:Acute Coronary Syndrome / Q000601:surgery*; D000368:Aged; D003324:Coronary Artery Disease / Q000601:surgery*; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods*; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome