Immediate versus staged complete revascularization in patients presenting with multivessel disease and ST- or non-ST-segment elevation acute coronary syndrome

Abstract

Background: Recent randomized trials have suggested that immediate complete revascularization (ICR) is a viable alternative to staged complete revascularization (SCR) in patients with acute coronary syndrome (ACS) and multivessel disease. However, long-term outcomes comparing ICR with SCR in ST-segment elevation (STE) and non-ST-segment elevation (NSTE) ACS remain unclear.

Methods: This study analyzes 2-year follow-up data from the BIOVASC trial, randomizing ACS patients to ICR or SCR. The primary composite endpoint includes all-cause mortality, myocardial infarction, unplanned ischemia-driven revascularization, and cerebrovascular events. Secondary endpoints evaluate these outcomes individually. Cox regression assessed if STE/NSTE-ACS diagnosis influences treatment effect.

Results: In 608 STE-ACS patients, the 2-year cumulative incidence of the primary composite endpoint was 10.9 % (ICR) and 11.7 % (SCR) (risk difference [RD] 0.8 %, 95 % confidence interval [CI] -4.3 % to 5.9 %; P = 0.71). In NSTE-ACS, cumulative incidence was 13.5 % (ICR) and 12.8 % (SCR) (RD -0.7 %, 95 % CI -5.1 % to 3.7 %; P = 0.90). No differential effect was observed comparing ICR with SCR between STE- and NSTE-ACS.

Conclusions: ICR did not sustain a significant benefit in terms of the primary and secondary outcomes at 2 years follow-up. In addition, no differential effect of ICR versus SCR was observed between STE-ACS and NSTE-ACS after 2 years follow-up. However, there seems to be a late catch-up in the cumulative event rate in patients randomized to ICR.

Keywords: Acute coronary syndrome; Complete revascularization.