Complete versus culprit only revascularization in non-ST-segment elevation myocardial infarction and multivessel coronary artery disease

Abstract

Introduction/Objective. The optimal percutaneous coronary intervention (PCI) in patients with non-ST elevated myocardial infarction (NSTEMI) and multivessel coronary artery disease (CAD) is still not clear. The aim of our study was to examine intrahospital and long term major adverse cardiovascular and cerebrovascular events (MACCE) in this group of patients. Methods. This retrospective study included 225 patients with NSTEMI and multivessel CAD treated with PCI at the Institute of Cardiovascular Diseases of Vojvodina. Three groups were formed: complete one stage PCI; complete multi stage PCI and culprit only PCI. We have analyzed intrahospital and one year follow up MACCE and mortality after three years in all three groups. Results. Complete one stage PCI was performed in 112 (49.8%), complete multi stage PCI in 70 (31.3%) and culprit only PCI in 43 (19.1%) of patients. Patients with multi stage complete PCI had lowest mortality in comparison with one stage and culprit only PCI, respectively, both intrahospital (0% vs. 0.9% or 20.9%, p < 0.0005) and after one year (0% vs. 2.7% or 30.2%, p < 0.0005) and three years (4.3% vs. 5.4% or 32.6%, p < 0.0005). There was no significant difference in other MACCE between groups both intrahospital and after one year. Conclusion. In our study, multi stage PCI significantly reduces intrahospital, one year and three years follow up mortality in patients with NSTEMI and multivessel CAD.