"One-Time" versus Staged Multivessel Intervention in Intermediate to Very High-Risk Patients with Non-ST-Segment Elevation Acute Coronary Syndromes.
OBJECTIVE
To compare clinical outcomes of staged versus "one-time" percutaneous coronary intervention (PCI) in intermediate to very high-risk patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) and multivessel coronary disease (MVD).


METHODS
1531 NSTE-ACS patients with multivessel PCI and meeting the criteria of intermediate to very high risk were screened from a prospectively registered database obtained from General Hospital of Shenyang Military Region between 2008 and 2012. They were categorized into "one-time" PCI (n=859) and staged PCI (n=672) according to intervention strategy. The primary outcomes included a 3-year major adverse cardiac event (MACE), a composite of cardiac death, myocardial infarction (MI), and target vessel revascularization.


RESULTS
At 3 years, no significant differences in MACE (20.8% vs. 19.7%, p=0.608) and cardiac death/MI (7.1% vs. 9.1%, p=0.129) were observed between the two groups. After propensity score matching, there was no statistical significance in MACE (18.9% vs. 21.8%, p=0.249); whereas cardiac death/MI was significantly lower in the staged PCI group (7.0% vs.11.1%, p=0.033). Ninety-day landmark analysis showed that the staged PCI group had a lower 90-day incidence of MACE (1.2% vs. 3.3%, p= 0.037) and cardiac death/MI (0.7% vs. 2.6%, p=0.031). For the 90-day to 3-year follow-up period, the incidences of MACE (17.9% vs. 19.1%, p=0.641) and cardiac death/MI (6.3% vs. 8.7%, p=0.191) were similar in both groups.


CONCLUSIONS
In intermediate- to very high-risk NSTE-ACS patients with MVD, staged PCI is superior to "one-time" PCI in terms of cardiac death/MI.
Department of Cardiology, The Second Hospital of Dalian Medical University, Dalian, Liao Ning, China.; Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, Liao Ning, China.; Department of Cardiology, Anhui Provincial Hospital, Hefei, Anhui, China.
Xiaofan
X
Yu
Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, Liao Ning, China.
Yi
Y
Li
Department of Cardiology, The Second Hospital of Dalian Medical University, Dalian, Liao Ning, China.
Qiancheng
Q
Wang
Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, Liao Ning, China.
Ming
M
Liang
Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, Liao Ning, China.
Kai
K
Xu
Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, Liao Ning, China.
Yaling
Y
Han
Acute coronary syndromes; Coronary artery disease; Percutaneous coronary intervention