title: Single-vessel or multivessel PCI in patients with multivessel disease presenting with non-ST-elevation acute coronary syndromes.
abstract: OBJECTIVE
  Coronary artery disease is often diffuse and patients with non-ST-segment acute coronary syndromes (NSTE-ACS) demonstrate multivessel coronary disease. The purpose of this study was to clarify whether interventions on stable chronic non-culprit lesions in patients with NSTE-ACS can prevent future adverse events.
  
  
  RESULTS
  We performed a retrospective cohort study of 990 consecutive patients who underwent either single-vessel PCI (SVPCI: n=379) or multivessel PCI (MVPCI: n=611) in a setting of NSTE-ACS. Cox proportional hazards regression analysis was performed to compensate for differences in baseline characteristics between the groups. To minimise the impact of confounding factors, we performed propensity matching (SVPCI: n=230, MVPCI: n=230). Patients who had MVPCI had a lower rate of prior interventional treatment or myocardial infarction, and more complex lesions than patients with SVPCI. At three years, all-cause mortality was significantly lower in the MVPCI group than the SVPCI group (13.0% vs. 18.3%, p=0.02, adjusted HR 0.55, 95% CI: 0.38-0.80), while the rates of target vessel revascularisation and a composite of all-cause death or myocardial infarction were not different between the groups. In the propensity-matched cohort, all-cause death remained significantly lower in the MVPCI group (adjusted HR 0.41, 95% CI: 0.22-0.75) compared to the SVPCI group.
  
  
  CONCLUSIONS
  In this retrospective study, multivessel PCI reduced all-cause mortality in a setting of NSTE-ACS compared to single-vessel PCI. Further investigations to confirm these results are warranted.
authors.affiliation: Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Onuma
authors.forename: Takashi
authors.initials: T
authors.lastname: Muramatsu
authors.forename: Chrysafios
authors.initials: C
authors.lastname: Girasis
authors.forename: Neville
authors.initials: N
authors.lastname: Kukreja
authors.forename: Hector M
authors.initials: HM
authors.lastname: Garcia-Garcia
authors.forename: Joost
authors.initials: J
authors.lastname: Daemen
authors.forename: Nieves
authors.initials: N
authors.lastname: Gonzalo
authors.forename: Nicolo
authors.initials: N
authors.lastname: Piazza
authors.forename: Jannet
authors.initials: J
authors.lastname: Einthoven
authors.forename: Ron
authors.initials: R
authors.lastname: van Domburg
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000401:mortality / Q000628:therapy*; D000368:Aged; D000369:Aged, 80 and over; D003324:Coronary Artery Disease / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality / Q000628:therapy*; D009204:Myocardial Revascularization / Q000379:methods; D062645:Percutaneous Coronary Intervention; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome