TY - JOUR
T1 - A riddle of culprit only vs multivessel or immediate vs staged revascularization in patients with non-ST elevation acute coronary syndrome
T2 - A meta-analysis
AU - Oktaviono, Yudi Her
AU - Arnindita, Jannatin Nisa
AU - Saputra, Pandit Bagus Tri
AU - Wairooy, Nabilah Azzah Putri
AU - Damayanti, Arlia Ayu
AU - Hutomo, Suryo Ardi
AU - Pratama, Nando Reza
AU - Al Farabi, Makhyan Jibril
AU - Ashari, Faisal Yusuf
N1 - Publisher Copyright:
© 2025 Oktaviono et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2025/3
Y1 - 2025/3
N2 - Background Percutaneous coronary intervention (PCI) is a revolutionary breakthrough in saving many lives from myocardial infarction. However, little is known about the PCI strategy in multivessel disease (MVD) Non-ST Elevation Acute Coronary Syndrome (NSTE-ACS) patients. Should complete revascularization be achieved or culprit-only is sufficient, then when the appropriate time of multivessel revascularization is, whether it is staged or immediate. Limited evidence is available on this matter compared to ST-elevation myocardial infarction (STEMI), even though NSTE-ACS patients carry poorer long-term prognoses compared to STEMI. Methods A thorough search for appropriate studies was executed across PubMed, Embase, Medline, Science Direct, and Scopus databases until July 4th, 2023. The risk ratio (RR) underwent analysis through Review Manager 5.4. Results Twenty-six studies with 222,350 MVD NSTE-ACS patients were included. Culprit-only revascularization was significantly related to a higher risk of non-fatal MI (RR: 1.41, 95% CI: 1.04-1.91, p= 0.03, I2 : 65%) and all-repeat revascularization (RR 1.86, 95% CI 1.07- 3.25, p=0.03). While multistage multivessel revascularization was related to significantly higher all-cause mortality (RR: 1.73; 95% CI 1.43-2.10; p< 0.01; I2 : 0%), TVR repeat (RR 1.38 95% CI 1.11-1.73, I2 = 18%, p=0.004), and non-TVR repeat (RR 2.59; 95% CI 1,56- 4.30; p=0.0002; I2 : 70%). Conclusion Patients with MVD NSTE-ACS treated with multivessel revascularization showed more favorable results than culprit-only. One-stage multivessel revascularization resulted in fewer adverse events than multistage. Additionally, a comprehensive and methodical prospective investigation is required to validate the factors accountable for these outcomes.
AB - Background Percutaneous coronary intervention (PCI) is a revolutionary breakthrough in saving many lives from myocardial infarction. However, little is known about the PCI strategy in multivessel disease (MVD) Non-ST Elevation Acute Coronary Syndrome (NSTE-ACS) patients. Should complete revascularization be achieved or culprit-only is sufficient, then when the appropriate time of multivessel revascularization is, whether it is staged or immediate. Limited evidence is available on this matter compared to ST-elevation myocardial infarction (STEMI), even though NSTE-ACS patients carry poorer long-term prognoses compared to STEMI. Methods A thorough search for appropriate studies was executed across PubMed, Embase, Medline, Science Direct, and Scopus databases until July 4th, 2023. The risk ratio (RR) underwent analysis through Review Manager 5.4. Results Twenty-six studies with 222,350 MVD NSTE-ACS patients were included. Culprit-only revascularization was significantly related to a higher risk of non-fatal MI (RR: 1.41, 95% CI: 1.04-1.91, p= 0.03, I2 : 65%) and all-repeat revascularization (RR 1.86, 95% CI 1.07- 3.25, p=0.03). While multistage multivessel revascularization was related to significantly higher all-cause mortality (RR: 1.73; 95% CI 1.43-2.10; p< 0.01; I2 : 0%), TVR repeat (RR 1.38 95% CI 1.11-1.73, I2 = 18%, p=0.004), and non-TVR repeat (RR 2.59; 95% CI 1,56- 4.30; p=0.0002; I2 : 70%). Conclusion Patients with MVD NSTE-ACS treated with multivessel revascularization showed more favorable results than culprit-only. One-stage multivessel revascularization resulted in fewer adverse events than multistage. Additionally, a comprehensive and methodical prospective investigation is required to validate the factors accountable for these outcomes.
UR - http://www.scopus.com/inward/record.url?scp=105000229696&partnerID=8YFLogxK
U2 - 10.1371/journal.pone.0310695
DO - 10.1371/journal.pone.0310695
M3 - Article
C2 - 40100813
AN - SCOPUS:105000229696
SN - 1932-6203
VL - 20
JO - PLoS ONE
JF - PLoS ONE
IS - 3 March
M1 - e0310695
ER -