title: Staged versus "one-time" multivessel intervention in elderly patients with non-ST-elevation acute coronary syndrome.
abstract: OBJECTIVE
  To evaluate the clinical outcomes of "one-time" versus staged multivessel stenting in elderly (≥ 60 years) patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) and multivessel disease (MVD).
  
  
  METHODS
  We analyzed data of consecutive NSTE-ACS patients with multivessel percutaneous coronary intervention (PCI) who were enrolled in General Hospital of Shenyang Military Region between 2008 and 2012. A total of 1090 eligible patients aged ≥ 60 were further categorized into "one-time" group (n= 623) and staged PCI group (n= 467) according to intervention strategy. The primary endpoint was composite outcome of myocardial infarction (MI) or cardiac death during 3-year follow-up.
  
  
  RESULTS
  The estimated 3-year composite rate of cardiac death or MI was 7.0% in the staged PCI group and 9.5% in the "one-time" group (P= 0.110). Multivariate analysis confirmed the benefit of staged PCI on the primary events in the elderly (HR: 0.638, 95% CI: 0.408-0.998,P= 0.049). In a propensity score matched cohort, staged PCI was associated with lower rates of primary events (6.1%vs. 10.4%,P= 0.046) and MI (3.4%vs. 7.4%,P= 0.037) at three years. In addition, there were reduced trends in the stent thrombosis at 30 days (0.3%vs. 1.4%,P= 0.177) and at three years (1.1%vs. 2.4%,P= 0.199) in the staged PCI group. There was no significant difference in the 3-year target vessel revascularization (15.5%vs. 14.4%,P= 0.746).
  
  
  CONCLUSIONS
  In elderly NSTE-ACS patients with MVD, staged PCI might be an optimal strategy associated with reduced long-term cardiac death or MI compared with "one-time" PCI strategy, which needs further confirmation.
authors.affiliation: Department of Cardiology, the Second Hospital of Dalian Medical University, Dalian, Liaoning, China; Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, Liaoning, China.
authors.forename: Xiao-Fan
authors.initials: XF
authors.lastname: Yu
authors.affiliation: Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, Liaoning, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Cardiology, the Second Hospital of Dalian Medical University, Dalian, Liaoning, China.
authors.forename: Qian-Cheng
authors.initials: QC
authors.lastname: Wang
authors.affiliation: Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, Liaoning, China.
authors.forename: Xiao-Zeng
authors.initials: XZ
authors.lastname: Wang
authors.affiliation: Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, Liaoning, China.
authors.forename: Ming
authors.initials: M
authors.lastname: Liang
authors.affiliation: Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, Liaoning, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Zhao
authors.affiliation: Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, Liaoning, China.
authors.forename: Kai
authors.initials: K
authors.lastname: Xu
authors.affiliation: Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, Liaoning, China.
authors.forename: Ya-Ling
authors.initials: YL
authors.lastname: Han
keywords: Multivessel revascularization; Non-ST-elevation acute coronary syndrome; Percutaneous coronary intervention