Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2024 Dec 23;17(24):2866-2874.
doi: 10.1016/j.jcin.2024.09.058.

Timing of Complete Multivessel Revascularization in Acute Coronary Syndrome: 2-Year Results of the BIOVASC Study

Wijnand K den Dekker  1 , Jacob J Elscot  2 , Johan Bennett  3 , Carl E Schotborgh  4 , Rene van der Schaaf  5 , Manel Sabaté  6 , Raúl Moreno  7 , Koen Ameloot  8 , Rutger van Bommel  9 , Daniele Forlani  10 , Bert van Reet  11 , Giovanni Esposito  12 , Maurits T Dirksen  13 , Willem P T Ruifrok  14 , Bert R C Everaert  15 , Carlos Van Mieghem  16 , Paul Cummins  2 , Mattie Lenzen  2 , Salvatore Brugaletta  6 , Eric Boersma  2 , Nicolas M Van Mieghem  2 , Roberto Diletti  2 ; BIOVASC Investigators
Collaborators, Affiliations
Free article
Randomized Controlled Trial

Timing of Complete Multivessel Revascularization in Acute Coronary Syndrome: 2-Year Results of the BIOVASC Study

Wijnand K den Dekker et al. JACC Cardiovasc Interv. .
Free 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 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. (Direct Complete Versus Staged Complete Revascularization in Patients Presenting With Acute Coronary Syndromes and Multivessel Disease [BioVasc]; NCT03621501).

Keywords: acute coronary syndrome(s); immediate complete revascularization; multivessel disease; staged complete revascularization.

PubMed Disclaimer

Conflict of interest statement

Funding Support and Author Disclosures Biotronik provided an unrestricted research grant. Dr Diletti has received institutional research grants from Biotronik, Medtronic, ACIST Medical Systems, and Boston Scientific. Dr den Dekker has received institutional research grants from Biotronik. Dr Van Mieghem has received institutional research grants from Biotronik, Abbott, Medtronic, Edwards Lifesciences, PulseCath, Abiomed, and Daiichi-Sankyo; has received speaker fees from Abiomed and Amgen; and has received a travel grant from JenaValve. Dr Bennett has received institutional grants from Biotronik, Abbott Vascular, and Shockwave Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Publication types

MeSH terms

Associated data

LinkOut - more resources