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Addressing, in a randomised fashion, the problem regarding the decision to perform single or multivessel percutaneous coronary intervention (PCI) in patients with stable coronary artery disease (SCAD) or non-ST elevation acute coronary syndrome (NSTE-ACS) in cases of multivessel disease.
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Adding to the above discussion in a hypothesis-generating way.
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Single (culprit) vessel PCI might be non-inferior to multivessel PCI for patients with SCAD/NSTE-ACS with respect to clinical endpoints and major adverse cardiac events.
Introduction
Methods
Study design
Procedure
Follow-up
Outcome
Statistical analysis
Results
baseline characteristic | culprit (n = 103) | complete (n = 105) | p-value |
---|---|---|---|
age (years), mean (SD) | 64.4 (10) | 66.4 (10) | 0.138 |
male, n (%) | 78 (76) | 72 (69) | 0.281 |
female, n (%) | 25 (24) | 33 (31) | 0.281 |
previous MI, n (%) | 35 (34) | 36 (34) | 1.000 |
CABG, n (%) | 1 (1) | 1 (1) | 1.000 |
PCI, n (%) | 14 (14) | 21 (20) | 0.267 |
hypertension, n (%) | 55 (53) | 52 (50) | 0.582 |
current smoker, n (%) | 18 (19) | 25 (25) | 0.427 |
diabetic, n (%) | 17 (17) | 25 (24) | 0.228 |
hypercholesterolaemia, n (%) | 33 (32) | 31 (30) | 0.765 |
anticoagulation, n (%) | 7 (7) | 5 (5) | 0.567 |
anti-platelet agent, n (%) | 96 (93) | 98 (93) | 1.000 |
nitrate, n (%) | 38 (37) | 38 (36) | 1.000 |
beta-blocker, n (%) | 90 (88) | 90 (86) | 0.681 |
calcium antagonist, n (%) | 26 (25) | 37 (35) | 0.133 |
diuretics, n (%) | 20 (20) | 24 (23) | 0.612 |
ACE inhibitor, n (%) | 28 (27) | 37 (35) | 0.233 |
angiotensin II receptor blocker, n (%) | 15 (15) | 9 (9) | 0.198 |
statin, n (%) | 96 (93) | 93 (89) | 0.336 |
angina pectoris CCS, n (%) | |||
– I | 2 (2) | 4 (4) | |
– II | 36 (35) | 33 (31) | |
– III | 30 (29) | 24 (23) | |
NSTE-ACS | 34 (33) | 42 (40) | 0.316 |
procedural characteristic | culprit (n = 103) | complete (n = 105) | p-value |
---|---|---|---|
number of lesions ≥70%, mean (SD) | 2.1 (0.2) | 2.1 (0.23) | 0.973 |
significantly diseased vessels, n (%) | |||
– 2-vessel disease | 97 (94) | 99 (94) | |
– 3-vessel disease | 6 (6) | 6 (6) | 1.000 |
location of culprit vessel, n (%) | |||
– LAD | 44 (43) | 48 (46) | |
– RCX | 29 (28) | 22 (21) | |
– RCA | 30 (29) | 35 (33) | 0.472 |
location of non-culprit vessel lesion 1, n (%) | |||
– LAD | 36 (35) | 29 (28) | |
– RCX | 35 (34) | 49 (47) | |
– RCA | 32 (31) | 27 (26) | 0.174 |
strategy success | 99 (96) | 99 (94) | 0.748 |
pre-procedural TIMI grade flow
Culprit vessel
| |||
– 0 | 6 (6) | 4 (4) | 0.508 |
– I | 6 (6) | 3 (3) | |
– II | 7 (7) | 11 (11) | |
– III | 83 (81) | 86 (83) | |
type of stent
| |||
– taxus | 59 | 55 | |
– xience | 13 | 18 | |
– pro-Kinetic | 0 | 1 | |
– promus | 13 | 13 | |
– janus | 1 | 3 | |
– cypher | 3 | 0 | |
– titan | 1 | 0 | |
– combination | 2 | 4 | |
– no stent | 0 | 1 | |
peri-procedural complications, n (%) | |||
– side branch occlusion | 3 (3) | 5 (1) | 0.722 |
– coronary spasm | 1 (1) | 0 (0) | 0.490 |
– coronary embolism | 0 (0) | 0 (0) | |
– acute stent thrombosis | 0 | 0 | |
– bleeding | 0 | 0 | |
– MI | 1 (1) | 4 (4) | |
– TIA/CVA | 0 | 0 | |
– death | 0 | 0 | 0.370 |
– other | 4 (4) | 8 (8) | 0.374 |
clinical events | complete n = 105 | culprit n = 103 | HR | CI (95%) | p-value |
---|---|---|---|---|---|
overall MACE (%) | 29 (28) | 32 (31) | 0.87 | 0.53–1.44 | 0.589 |
all-cause mortality | 11 (10) | 5 (5) | 2.24 | 0.78–6.45 | 0.135 |
acute MI | 4 (4) | 3 (3) | 1.36 | 0.30–6.08 | 0.688 |
CABG | 2 (2) | 4 (4) | 0.51 | 0.09–2.77 | 0.432 |
repeat PCI | 14 (13) | 21 (20) | 0.65 | 0.33–1.27 | 0.204 |
total revascularisation (PCI or CABG) | 16 (15) | 25 (24) | 0.59 | 0.32–1.11 | 0.105 |
combined death or MI | 13 (12) | 7 (7) | 1.92 | 0.78–4.81 | 0.164 |
angina pectoris at 5‑year FU
| |||||
– class I | 3 (3) | 3 (3) | |||
– class II | 9 (9) | 8 (8) | |||
– class III | 2 (2) | 0 (0) | |||
stent thrombosis
| 0.442 | ||||
– definite | 1 (1) | 0 (0) | |||
– probable | 1 (1) | 0 (0) |