Ten-Year Outcomes Following Revascularization Strategies for Non-ST-Segment Elevation Myocardial Infarction and Multivessel Disease

Abstract

Objective: There remain conflicting recommendations regarding revascularization strategies for patients with non-ST-segment elevation myocardial infarction (NSTEMI) and multivessel disease (MVD). This study aimed to compare the long-term outcomes of different revascularization strategies. Method: Patients with similar characteristics were categorized into three groups: immediate complete revascularization (ICR), staged complete revascularization (SCR), and non-complete revascularization (NCR). The SCR group was further divided based on the time interval between the index and staged procedures: SCR ≤ 24 hours and SCR > 24 hours. Cardiac composite outcomes included the total number of cardiac deaths and recurrent myocardial infarction during the follow-up period. Results: Out of 14,511 screened patients, 316 were included in the analysis. The results showed a significant difference in risk between SCR and ICR (hazard ratio [HR] (95% confidence interval [CI]): 0.27 (0.15-0.47); P = 0.001). There was no significant difference between NCR and SCR (HR (95% CI): 1.06 (0.61-1.84); P = 0.832). The SCR group was divided into two groups based on the time interval from the first to the second procedure (time interval [TI] ≤ 24 hours in the SCR1 group, and TI > 24 hours in the SCR2 group). The frequency of cardiac composite outcomes was lower in SCR1 compared to SCR2 (16.7% vs. 47.1%; P = 0.038). Conclusion: Our findings support the use of ICR and SCR completed within 24 hours due to their favorable long-term outcomes in patients with MVD and NSTEMI.