Multivessel revascularization in non-ST segment elevation acute coronary syndromes: A systematic review and meta-analysis of 182,798 patients

Emiliano Bianchini; Mattia Basile; Francesco Bianchini; Andrea Zito; Enrico Romagnoli; Cristina Aurigemma; Lazzaro Paraggio; Mattia Lunardi; Renzo Laborante; Francesco Fracassi; Rocco Antonio Montone; Antonio Maria Leone; Giuseppe Biondi-Zoccai; Carlo Trani; Francesco Burzotta

doi:10.1016/j.ijcard.2024.132392

Multivessel revascularization in non-ST segment elevation acute coronary syndromes: A systematic review and meta-analysis of 182,798 patients

Int J Cardiol. 2024 Oct 15:413:132392. doi: 10.1016/j.ijcard.2024.132392. Epub 2024 Jul 25.

Authors

Affiliations

¹ Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
² Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica Sacro Cuore, Rome, Italy.
³ Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica Sacro Cuore, Rome, Italy; Center of Excellence in Cardiovascular Sciences, Ospedale Isola Tiberina - Gemelli Isola, Rome, Italy.
⁴ Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Mediterranea Cardiocentro, Napoli, Italy.
⁵ Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica Sacro Cuore, Rome, Italy. Electronic address: francesco.burzotta@policlinicogemelli.it.

PMID: 39067526
DOI: 10.1016/j.ijcard.2024.132392

Abstract

Background: Patients experiencing non-ST segment elevation acute-coronary-syndromes (NSTE-ACS) often present with multivessel-coronary-artery-disease (MVD). An immediate complete multivessel revascularization (MVR) - within the index hospitalization - may be considered the default therapeutic strategy, although its risk-to-benefit profile has not been definitively established through dedicated clinical trials.

Methods: A systematic review and meta-analysis, adhering to MOOSE and PRISMA guidelines, was conducted to assess studies comparing immediate MVR versus a conservative culprit-only revascularization (COR) in NSTE-ACS with MVD. The main endpoints were all-cause death, major adverse cardiovascular events (MACE) and non-fatal myocardial infarction (MI). The incidence of any revascularization or further percutaneous-coronary-interventions (PCIs) were also collected. The primary analyses for the main endpoints were conducted on propensity-matched groups only.

Results: A total of 22 studies (182,798 patients) were identified. 7 studies, encompassing 11,372 patients, were included in the primary analysis of propensity score-matched groups. Immediate MVR significantly increased (28%) survival (OR 0.72, 95% CI 0.58-0.90, P < 0.01) along with a 35% reduction in MACE (OR 0.65, 95% CI 0.47-0.88, P = 0.01) and a 60% decrease in MI (OR 0.40, 95% CI 0.25-0.63, P < 0.01) during a mean 3-years follow-up compared to the propensity score-matched COR group. Results were consistent in the unmatched analyses.

Conclusions: This meta-analysis supports an immediate MVR for improving clinical outcomes in patients with NSTE-ACS and MVD as compared to a conservative immediate COR. These data prompt further evaluations regarding optimal strategies in the pursuit of MVR, including patient selection, revascularization modality, and assessment methods of revascularization completeness.

Keywords: Multivessel coronary artery disease; Multivessel revascularization; Non-ST segment elevation acute coronary syndromes.

Publication types

Systematic Review
Meta-Analysis

MeSH terms

Acute Coronary Syndrome* / mortality
Acute Coronary Syndrome* / surgery
Humans
Myocardial Revascularization* / methods
Percutaneous Coronary Intervention / methods
Treatment Outcome