TY - JOUR
T1 - Timing of Complete Multivessel Revascularization in Acute Coronary Syndrome
T2 - 2-Year Results of the BIOVASC Study
AU - den Dekker, Wijnand K.
AU - Elscot, Jacob J.
AU - Bennett, Johan
AU - Schotborgh, Carl E.
AU - van der Schaaf, Rene
AU - Sabaté, Manel
AU - Moreno, Raúl
AU - Ameloot, Koen
AU - van Bommel, Rutger J.
AU - Forlani, Daniele
AU - van Reet, Bert
AU - Esposito, Giovanni
AU - Dirksen, Maurits T.
AU - Ruifrok, Willem P.T.
AU - Everaert, Bert R.C.
AU - Van Mieghem, Carlos
AU - Cummins, Paul
AU - Lenzen, Mattie
AU - Brugaletta, Salvatore
AU - Boersma, Eric
AU - Van Mieghem, Nicolas M.
AU - Diletti, Roberto
AU - den Dekker, Wijnand K.
AU - Van Mieghem, Nicolas M.
AU - Schotborgh, Carl E.
AU - van der Schaaf, René J.
AU - van Bommel, Rutger J.
AU - Dirksen, Maurits T.
AU - Ruifrok, Willem T.
AU - Jessurun, Gillian A.J.
AU - Magro, Michael
AU - Voskuil, Michiel
AU - Vlachojannis, George J.
AU - Beijk, Marcel A.M.
AU - Barzouhi, Abdelilah el
AU - van der Heijden, Dirk J.
AU - Bennett, Johan
AU - Ameloot, Koen
AU - Vrolix, Mathias
AU - Van Reet, Bert
AU - Everaert, Bert R.
AU - Vandeloo, Bert
AU - Van Mieghem, Carlos
AU - Stammen, Francis
AU - Verheye, Stefan
AU - Forlani, Daniele
AU - Di Marco, Massimo
AU - Paloscia, Leonardo
AU - Esposito, Giovanni
AU - Franzone, Anna
AU - Berti, Sergio
AU - De Caterina, Alberto R.
AU - Ciardetti, Marco
AU - Secco, Gioel G.
AU - Sabaté, Manel
AU - Brugaletta, Salvatore
AU - Moreno, Raúl
AU - Pinar, Eduardo
AU - Alfonso, Fernando
AU - Amat, Ignacio J.
AU - Moris, Cesar
AU - Sabaté, Manel
AU - Daemen, Joost
AU - Garcia-Garcia, Hector M.
AU - McFadden, Eugène
AU - Andersen, Grethe
AU - Tijssen, Jan G.P.
AU - ten Berg, Jurriën M.
AU - Verheugt, Freek W.A.
N1 - Publisher Copyright:
© 2024 The Authors
PY - 2024/12/23
Y1 - 2024/12/23
N2 - 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.
AB - 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.
KW - acute coronary syndrome(s)
KW - immediate complete revascularization
KW - multivessel disease
KW - staged complete revascularization
UR - http://www.scopus.com/inward/record.url?scp=85211507618&partnerID=8YFLogxK
U2 - 10.1016/j.jcin.2024.09.058
DO - 10.1016/j.jcin.2024.09.058
M3 - Article
AN - SCOPUS:85211507618
SN - 1936-8798
VL - 17
SP - 2866
EP - 2874
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
IS - 24
ER -