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Complete versus incomplete revascularization in patients with a non-ST-elevation myocardial infarction: Analysis from the e-ULTIMASTER registry

Lookup NU author(s): Dr Rajiv Das

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Abstract

© 2024 Elsevier LtdBackground: Incomplete revascularization (ICR) has been associated with a worse prognosis after a percutaneous coronary intervention (PCI). In NSTEMI patients with multivessel disease (MVD) however, the benefit of a complete revascularization (CR) remains unclear. Methods: Patients presenting with an NSTEMI and MVD were selected from the global e-ULTIMASTER registry and grouped according to completeness of revascularization at index hospitalization discharge. The primary endpoint was the patient oriented composite endpoint (POCE) defined as all death, any myocardial infarction, and any revascularization at 1 year. Target lesion failure (TLF) was defined as the composite of cardiac death, target vessel related myocardial infarction and clinically driven target lesion revascularization. Inverse propensity score weighting (IPSW) was performed to harmonize the patient's baseline characteristics between the groups. Results: CR was achieved in 1800 patients (47.0 %) and ICR in 2032 patients (53.0 %). The incidence of POCE at 1 year was lower in the CR group compared to the ICR group: 7.0 % vs. 12.9 %, p < 0.0001. Similarly for TLF at 1 year: 3.6 % vs. 5.5 %, p < 0.01. After IPSW, the incidence of POCE was 7.7 % vs. 12.0 %, p < 0.0001, due to a lower all-cause mortality: 2.7 % vs. 4.2 %, p = 0.02 and less revascularizations: 4.9 % vs. 7.9 %, p < 0.001. The incidence of TLF was no longer statistically significant: CR 3.9 % vs. IR 5.0 %, p = 0.10. Conclusions: Patients with a NSTEMI and multi vessel disease undergoing a percutaneous coronary revascularization with a complete revascularization during index hospitalization have better 1-year clinical outcomes. Randomized studies are warranted to confirm these results.

Publication metadata

Author(s): Jimenez Diaz VA, Routledge H, Malik F-T-N, Hildick-Smith D, Guedes A, Baello P, Kuramitsu S, Das R, Dewilde W, Portales JF, Angioi M, Smits PC, Romo AI

Publication type: Article

Publication status: Published

Journal: Cardiovascular Revascularization Medicine

Year: 2024

Pages: epub ahead of print

Online publication date: 22/07/2024

Acceptance date: 17/07/2024

ISSN (print): 1553-8389

ISSN (electronic): 1878-0938

Publisher: Elsevier Inc.

URL: https://doi.org/10.1016/j.carrev.2024.07.011

DOI: 10.1016/j.carrev.2024.07.011

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