Revascularization following non‐ST elevation myocardial infarction in multivessel coronary disease
- 3 May 2020
- journal article
- research article
- Published by Hindawi Limited in Journal of Cardiac Surgery
- Vol. 35 (6), 1195-1201
- https://doi.org/10.1111/jocs.14539
Abstract
Background The optimal revascularization approach for patients with multivessel coronary artery disease (MVCAD) is controversial. We sought to investigate outcomes in patients undergoing coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) for non‐ST elevation myocardial infarction (NSTEMI). Methods Adult patients with MVCAD and NSTEMI undergoing either CABG or PCI at a single institution between 2011 and 2018 were included. Multivariable analysis was utilized to determine independent predictors of death, major adverse cardiac and cerebrovascular events (MACCE), and readmissions. A subanalysis examined patients undergoing complete revascularization. Results A total of 2001 patients were included, of whom 1480 (74.0%) underwent CABG. CABG was associated with a lower risk‐adjusted hazard for death (hazard ratio, 0.59, P < .001) and with improved survival at 1 year (92.0 vs 81.8%, P < .001) and 5 years (80.7 vs 63.3%, P < .001). Additionally, freedom from MACCE (P < .001) was greater in the CABG group and cumulative readmission, rates of MI, and rates of repeat revascularization were lower with CABG (each P < .001). Among patients undergoing complete revascularization, overall survival (1 year: 92.7 vs 83.9%, P = .010; 5 years: 81.1 vs 69.4%, P < .001) and freedom from MACCE (1 year: 92.3 vs 75.2%, P < .001; 5 years: 81.7 vs 61.4%, P < .001) remained higher for the CABG group; cumulative incidence of readmission was also decreased in those undergoing CABG (P < .001). Conclusions In this real‐world analysis of patients with MVCAD presenting with NSTEMI, revascularization with CABG resulted in improved survival with lower rates of MACCE and readmission as compared to PCI, which persisted when accounting for complete revascularization.Keywords
This publication has 22 references indexed in Scilit:
- Does early coronary artery bypass surgery improve survival in non-ST acute myocardial infarction?Interactive CardioVascular and Thoracic Surgery, 2013
- Cost-Effectiveness of Percutaneous Coronary Intervention With Drug Eluting Stents Versus Bypass Surgery for Patients With Diabetes Mellitus and Multivessel Coronary Artery DiseaseCirculation, 2013
- Predicting long-term mortality in older patients after non–ST-segment elevation myocardial infarction: The CRUSADE long-term mortality model and risk scoreAmerican Heart Journal, 2011
- Mortality Trends for Non–ST‐segment Elevation Myocardial Infarction (NSTEMI) in the United States from 1988 to 2004Clinical Cardiology, 2011
- LONG-TERM MORTALITY ASSOCIATED WITH MULTIVESSEL VERSUS CULPRIT VESSEL ONLY PERCUTANEOUS CORONARY INTERVENTION FOR PATIENTS WITH ACUTE MYOCARDIAL INFARCTION: INSIGHTS FROM THE NATIONAL CARDIOVASCULAR CATHPCI DATA REGISTRYJournal of the American College of Cardiology, 2011
- Complete Revascularization in Patients Undergoing Multivessel PCI is an Independent Predictor of Improved Long‐term SurvivalJournal of Interventional Cardiology, 2010
- Drug-Eluting Stents vs. Coronary-Artery Bypass Grafting in Multivessel Coronary DiseaseThe New England Journal of Medicine, 2008
- Outcomes of Coronary Artery Bypass Grafting Versus Percutaneous Coronary Intervention With Drug-Eluting Stents for Patients With Multivessel Coronary Artery DiseaseCirculation, 2007
- Comparison of Outcome in Patients With ST-Elevation Versus Non–ST-Elevation Acute Myocardial Infarction Treated With Percutaneous Coronary Intervention (from the National Heart, Lung, and Blood Institute Dynamic Registry)The American Journal of Cardiology, 2007
- Five-Year Follow-Up of the Argentine Randomized Trial of Coronary Angioplasty With Stenting Versus Coronary Bypass Surgery in Patients With Multiple Vessel Disease (ERACI II)Journal of the American College of Cardiology, 2005