Complete and incomplete revascularization in non-ST segment myocardial infarction with multivessel disease: long-term outcomes of first- and second-generation drug-eluting stents

• Published in: Heart and vessels 2019-02, Vol.34 (2), p.251-258
• Main Authors: Hsieh, Ming-Jer, Chen, Chun-Chi, Lee, Cheng-Hung, Wang, Chao-Yung, Chang, Shang-Hung, Chen, Dong-Yi, Yang, Chia-Hung, Tsai, Ming-Lung, Yeh, Jih-Kai, Ho, Ming-Yun, Hsieh, I-Chang
• Format: Article
• Language: English
• Subjects: Biomedical Engineering and Bioengineering; Cardiac Surgery; Cardiology; Coronary Angiography; Drug delivery; Drug-Eluting Stents; Female; Follow-Up Studies; Heart attacks; Humans; Implants; Kidney diseases; Male; Medicine; Medicine & Public Health; Middle Aged; Myocardial infarction; Non-ST Elevated Myocardial Infarction - diagnosis; Non-ST Elevated Myocardial Infarction - surgery; Original Article; Patients; Percutaneous Coronary Intervention - methods; Prosthesis Design; Registries; Reperfusion; Segments; Stents; Time Factors; Treatment Outcome; Vascular Surgery
• ISSN: 0910-8327; 1615-2573
• DOI: 10.1007/s00380-018-1252-z

The therapeutic effects of reperfusion strategies with complete revascularization (CR) or incomplete revascularization (IR) in non-ST segment myocardial infarction (NSTEMI) patients with multivessel disease (MVD) are controversial. In such patients, whether utilization of different generations of drug-eluting stents (DES) for IR or CR affect long-term major adverse cardiovascular events (MACE) is unknown. This study included 702 NSTEMI patients with MVD who received first-generation (1G) or second-generation (2G) DES. In multivariable analysis, chronic kidney disease, chronic total, 1G DES and IR were independent predictors of long-term MACE. In patients receiving 1G DES, no significant differences of MACE were observed between the IR and CR groups (39.1% vs. 36.2%, p  = 0.854). However, in patients receiving 2G DES, significantly fewer MACE were observed in the CR group than in the IR group (3.7% vs. 10.2%, p  = 0.002). Compared with patients receiving 1G DES for IR, those receiving 2G DES for IR and CR exhibited significantly lower risk of MACE (59% and 83% lower, respectively). CR could not provide clinical benefits over IR in NSTEMI patients with MVD receiving 1G DES. However, in patients receiving 2G DES, compared with IR, CR was associated with a lower risk of long-term MACE, which was mainly caused by low rates of non-TLR and any revascularization.