Timing of Complete Multivessel Revascularization in Acute Coronary Syndrome: 2-Year Results of the BIOVASC Study
Publication date
2024-12-23
Authors
den Dekker, Wijnand K.
Elscot, Jacob J.
Bennett, Johan
Schotborgh, Carl E.
van der Schaaf, Rene
Sabaté, Manel
Moreno, Raúl
Ameloot, Koen
van Bommel, Rutger J.
Forlani, Daniele
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Advisors
Supervisors
Document Type
Article
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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.
Keywords
acute coronary syndrome(s), immediate complete revascularization, multivessel disease, staged complete revascularization, Cardiology and Cardiovascular Medicine
Citation
den Dekker, W K, Elscot, J J, Bennett, J, Schotborgh, C E, van der Schaaf, R, Sabaté, M, Moreno, R, Ameloot, K, van Bommel, R J, Forlani, D, van Reet, B, Esposito, G, Dirksen, M T, Ruifrok, W P T, Everaert, B R C, Van Mieghem, C, Cummins, P, Lenzen, M, Brugaletta, S, Boersma, E, Van Mieghem, N M, Diletti, R, den Dekker, W K, Van Mieghem, N M, Schotborgh, C E, van der Schaaf, R J, van Bommel, R J, Dirksen, M T, Ruifrok, W T, Jessurun, G A J, Magro, M, Voskuil, M, Vlachojannis, G J, Beijk, M A M, Barzouhi, A E, van der Heijden, D J, Bennett, J, Ameloot, K, Vrolix, M, Van Reet, B, Everaert, B R, Vandeloo, B, Van Mieghem, C, Stammen, F, Verheye, S, Forlani, D, Di Marco, M, Paloscia, L, Esposito, G, Franzone, A, Berti, S, De Caterina, A R, Ciardetti, M, Secco, G G, Sabaté, M, Brugaletta, S, Moreno, R, Pinar, E, Alfonso, F, Amat, I J, Moris, C, Sabaté, M, Daemen, J, Garcia-Garcia, H M, McFadden, E, Andersen, G, Tijssen, J G P, ten Berg, J M & Verheugt, F W A 2024, 'Timing of Complete Multivessel Revascularization in Acute Coronary Syndrome : 2-Year Results of the BIOVASC Study', JACC: Cardiovascular Interventions, vol. 17, no. 24, pp. 2866-2874. https://doi.org/10.1016/j.jcin.2024.09.058