Timing of Complete Multivessel Revascularization in Acute Coronary Syndrome: 2-Year Results of the BIOVASC Study
den Dekker, Wijnand K.; Elscot, Jacob J.; Bennett, Johan; Schotborgh, Carl E.; van der Schaaf, Rene; Sabaté, Manel; Moreno, Raúl; Ameloot, Koen; van Bommel, Rutger J.; Forlani, Daniele; van Reet, Bert; Esposito, Giovanni; Dirksen, Maurits T.; Ruifrok, Willem P.T.; Everaert, Bert R.C.; Van Mieghem, Carlos; Cummins, Paul; Lenzen, Mattie; Brugaletta, Salvatore; Boersma, Eric; Van Mieghem, Nicolas M.; Diletti, Roberto; den Dekker, Wijnand K.; Van Mieghem, Nicolas M.; Schotborgh, Carl E.; van der Schaaf, René J.; van Bommel, Rutger J.; Dirksen, Maurits T.; Ruifrok, Willem T.; Jessurun, Gillian A.J.; Magro, Michael; Voskuil, Michiel; Vlachojannis, George J.; Beijk, Marcel A.M.; Barzouhi, Abdelilah el; van der Heijden, Dirk J.; Bennett, Johan; Ameloot, Koen; Vrolix, Mathias; Van Reet, Bert; Everaert, Bert R.; Vandeloo, Bert; Van Mieghem, Carlos; Stammen, Francis; Verheye, Stefan; Forlani, Daniele; Di Marco, Massimo; Paloscia, Leonardo; Esposito, Giovanni; Franzone, Anna; Berti, Sergio; De Caterina, Alberto R.; Ciardetti, Marco; Secco, Gioel G.; Sabaté, Manel; Brugaletta, Salvatore; Moreno, Raúl; Pinar, Eduardo; Alfonso, Fernando; Amat, Ignacio J.; Moris, Cesar; Sabaté, Manel; Daemen, Joost; Garcia-Garcia, Hector M.; McFadden, Eugène; Andersen, Grethe; Tijssen, Jan G.P.; ten Berg, Jurriën M.; Verheugt, Freek W.A.
(2024) JACC: Cardiovascular Interventions, volume 17, issue 24, pp. 2866 - 2874
(Article)
Abstract
Background: In patients with acute coronary syndromes (ACS) and multivessel coronary disease, immediate complete revascularization was noninferior to staged complete revascularization for the primary composite outcome at 1 year. The authors report clinical outcomes at 2 years of follow-up. Methods: Patients with ACS and multivessel coronary disease were randomly assigned
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to immediate complete revascularization or to staged complete revascularization at 29 sites in Europe. The primary outcome was the composite of all-cause mortality, myocardial infarction, any unplanned ischemia-driven revascularization, and cerebrovascular event. Results: In total, 764 patients were enrolled and randomly allocated to the immediate complete revascularization arm and 761 to the staged complete revascularization arm. Two-year follow-up was complete for 97.6% of patients. At 2 years, the primary outcome had occurred in 12.5% of patients in the immediate complete revascularization group and 12.4% of patients in the staged complete revascularization group (HR: 0.98; 95% CI: 0.73-1.30; P = 0.88). Myocardial infarction occurred more frequently in the staged complete revascularization group (6.2% vs 3.8%; HR: 0.60; 95% CI: 0.37-0.96; P = 0.032). In the immediate complete revascularization and staged complete revascularization groups, the rates of all-cause mortality (3.3% vs 2.0%; HR: 1.67; 95% CI: 0.88-3.16; P = 0.12), any unplanned ischemia-driven revascularization (7.0% vs 7.9%; HR: 0.87; 95% CI: 0.60-1.26; P = 0.57), and cerebrovascular event (2.5% vs 1.7%; HR: 1.39; 95% CI: 0.68-2.83; P = 0.37) were not significantly different. Conclusions: In patients with ACS and multivessel disease, there was no significant difference between immediate complete revascularization and staged complete revascularization with respect to the composite outcome of all-cause mortality, myocardial infarction, any unplanned ischemia-driven revascularization, and cerebrovascular event at 2 years. Immediate complete revascularization was associated with a significant reduction in myocardial infarction, mainly due to fewer early events.
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Keywords: acute coronary syndrome(s), immediate complete revascularization, multivessel disease, staged complete revascularization, Cardiology and Cardiovascular Medicine
ISSN: 1936-8798
Publisher: Elsevier
Note: Publisher Copyright: © 2024 The Authors
(Peer reviewed)
