Timing of Complete Multivessel Revascularization in Acute Coronary Syndrome: 2-Year Results of the BIOVASC Study

Wijnand K. den Dekker*, Jacob J. Elscot, Johan Bennett, Carl E. Schotborgh, Rene van der Schaaf, Manel Sabaté, Raúl Moreno, Koen Ameloot, Rutger J. van Bommel, Daniele Forlani, Bert van Reet, Giovanni Esposito, Maurits T. Dirksen, Willem P.T. Ruifrok, Bert R.C. Everaert, Carlos Van Mieghem, Paul Cummins, Mattie Lenzen, Salvatore Brugaletta, Eric BoersmaNicolas M. Van Mieghem, Roberto Diletti, Wijnand K. den Dekker*, Nicolas M. Van Mieghem, Carl E. Schotborgh, René J. van der Schaaf, Rutger J. van Bommel, Maurits T. Dirksen, Willem T. Ruifrok, Gillian A.J. Jessurun, Michael Magro, Michiel Voskuil, George J. Vlachojannis, Marcel A.M. Beijk, Abdelilah el Barzouhi, Dirk J. van der Heijden, Johan Bennett, Koen Ameloot, Mathias Vrolix, Bert Van Reet, Bert R. Everaert, Bert Vandeloo, Carlos Van Mieghem, Francis Stammen, Stefan Verheye, Daniele Forlani, Massimo Di Marco, Leonardo Paloscia, Giovanni Esposito, Anna Franzone, Sergio Berti, Alberto R. De Caterina, Marco Ciardetti, Gioel G. Secco, Manel Sabaté, Salvatore Brugaletta, Raúl Moreno, Eduardo Pinar, Fernando Alfonso, Ignacio J. Amat, Cesar Moris, Manel Sabaté, Joost Daemen, Hector M. Garcia-Garcia, Eugène McFadden, Grethe Andersen, Jan G.P. Tijssen, Jurriën M. ten Berg, Freek W.A. Verheugt

*Corresponding author for this work

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Abstract

Background: In patients with acute coronary syndromes (ACS) and multivessel coronary disease, immediate complete revascularization was noninferior to staged complete revascularization for the primary composite outcome at 1 year. The authors report clinical outcomes at 2 years of follow-up. Methods: Patients with ACS and multivessel coronary disease were randomly assigned to immediate complete revascularization or to staged complete revascularization at 29 sites in Europe. The primary outcome was the composite of all-cause mortality, myocardial infarction, any unplanned ischemia-driven revascularization, and cerebrovascular event. Results: In total, 764 patients were enrolled and randomly allocated to the immediate complete revascularization arm and 761 to the staged complete revascularization arm. Two-year follow-up was complete for 97.6% of patients. At 2 years, the primary outcome had occurred in 12.5% of patients in the immediate complete revascularization group and 12.4% of patients in the staged complete revascularization group (HR: 0.98; 95% CI: 0.73-1.30; P = 0.88). Myocardial infarction occurred more frequently in the staged complete revascularization group (6.2% vs 3.8%; HR: 0.60; 95% CI: 0.37-0.96; P = 0.032). In the immediate complete revascularization and staged complete revascularization groups, the rates of all-cause mortality (3.3% vs 2.0%; HR: 1.67; 95% CI: 0.88-3.16; P = 0.12), any unplanned ischemia-driven revascularization (7.0% vs 7.9%; HR: 0.87; 95% CI: 0.60-1.26; P = 0.57), and cerebrovascular event (2.5% vs 1.7%; HR: 1.39; 95% CI: 0.68-2.83; P = 0.37) were not significantly different. Conclusions: In patients with ACS and multivessel disease, there was no significant difference between immediate complete revascularization and staged complete revascularization with respect to the composite outcome of all-cause mortality, myocardial infarction, any unplanned ischemia-driven revascularization, and cerebrovascular event at 2 years. Immediate complete revascularization was associated with a significant reduction in myocardial infarction, mainly due to fewer early events.

Original languageEnglish
Pages (from-to)2866-2874
Number of pages9
JournalJACC: Cardiovascular Interventions
Volume17
Issue number24
DOIs
Publication statusPublished - 23 Dec 2024

Keywords

  • acute coronary syndrome(s)
  • immediate complete revascularization
  • multivessel disease
  • staged complete revascularization

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