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The following is a summary of “Multivessel revascularization in non-ST segment elevation acute coronary syndromes: A systematic review and meta-analysis of 182,798 patients,” published in the October 2024 issue of Cardiology by Bianchini et al.
People with non-ST segment elevation acute coronary syndromes (NSTE-ACS) often have multivessel coronary artery disease (MVD). Treating all affected vessels in immediate multivessel revascularization (MVR) during the same hospital stay (complete MVR) is a potential strategy, but its benefits and risks are not fully clear yet.
Researchers conducted a retrospective study evaluating whether immediate complete MVR during the same hospital stay offers more benefits than risks for people with NSTE-ACS and MVD.
They conducted a systematic review and meta-analysis following MOOSE and PRISMA guidelines, comparing immediate MVR to conservative culprit-only revascularization (COR) in people with NSTE-ACS and MVD. Key outcomes included all-cause death, major adverse cardiovascular events (MACE), non-fatal heart attacks, and additional revascularizations, using only propensity-matched groups.
The results showed that 22 studies involving 182,798 patients were reviewed. In the primary analysis, 7 studies with 11,372 patients showed that immediate MVR improved survival by 28% (OR 0.72, 95% CI: 0.58-0.90, P<0.01). There was also a 35% reduction in major adverse cardiac events (MACE) (OR 0.65, 95% CI: 0.47-0.88, P=0.01) and a 60% decrease in myocardial infarction (MI) (OR 0.40, 95% CI: 0.25-0.63, P<0.01) during an average follow-up of 3 years compared to the matched control group. Results were consistent in unmatched analyses.
Investigators concluded that immediate MVR could enhance clinical outcomes for patients with NSTE-ACS and multivessel disease compared to conservative approaches. This encourages further research on the best strategies for MVR, including patient selection and assessment methods.
Source: sciencedirect.com/science/article/abs/pii/S0167527324010143
