title: Staged versus one-time complete revascularization with percutaneous coronary intervention for multivessel coronary artery disease patients without ST-elevation myocardial infarction.
abstract: BACKGROUND
  There are evidence-based guidelines for staging of patients with ST-elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI), but we are not aware of any evidence comparing the strategy of complete revascularization (CR) with PCI in the index admission versus the strategy of staging in a subsequent admission for patients with coronary artery disease without STEMI.
  
  
  RESULTS
  PCI patients without STEMI undergoing PCI in New York between 2007 and 2009 were separated into 2 groups: those with acute coronary syndrome but no STEMI, and those without acute coronary syndrome. For each group, patients who underwent CR in the index admission were then propensity matched to patients staged within 60 days to obtain CR based on 17 patient risk factors related to longer-term mortality, and 3-year mortality rates were compared for the propensity-matched groups. Outcomes were also compared for preselected subgroups. For propensity-matched patients without acute coronary syndrome, the all-cause mortality rates at 3 years for patients who underwent CR in the index hospitalization and patients staged for CR within 60 days of discharge were 5.62% and 5.97%, P=0.93, respectively. For propensity-matched patients with acute coronary syndrome but without STEMI, the all-cause mortality rates at 3 years for patients who underwent CR in the index hospitalization and patients staged for CR within 60 days of discharge were 6.59% and 5.92%, P=0.41, respectively.
  
  
  CONCLUSIONS
  Patients with coronary artery disease without STEMI do not have significantly lower 3-year mortality rates with staged PCI than when they undergo CR in the index admission.
authors: University at Albany, State University of New York, Albany, NY 12144-3456, USA. elh03@health.state.ny.us
authors: Edward L
authors: EL
authors: Hannan
authors: Zaza
authors: Z
authors: Samadashvili
authors: Gary
authors: G
authors: Walford
authors: Alice K
authors: AK
authors: Jacobs
authors: Nicholas J
authors: NJ
authors: Stamato
authors: Ferdinand J
authors: FJ
authors: Venditti
authors: David R
authors: DR
authors: Holmes
authors: Samin
authors: S
authors: Sharma
authors: Spencer B
authors: SB
authors: King
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D003331:Coronary Vessels / Q000601:surgery; D003631:Day Care, Medical / Q000706:statistics & numerical data*; D004562:Electrocardiography; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D009518:New York; D010343:Patient Admission / Q000706:statistics & numerical data*; D062645:Percutaneous Coronary Intervention; D017410:Practice Guidelines as Topic; D057216:Propensity Score; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome