Multivessel vs Single-Vessel Revascularization in Patients With Non-ST-Segment Elevation Acute Coronary Syndrome and Multivessel Disease in the Drug-Eluting Stent Era

Background: We sought to compare long-term outcomes for multivessel revascularization (MVR) vs single-vessel revascularization (SVR) with drug-eluting stents (DES) in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and multivessel coronary artery disease (MVD). Hypothesis: In DES era, MVR would improve long-term clinical outcomes in patients with NSTE-ACS. Methods: We studied 179 patients undergoing MVR and 187 patients undergoing SVR for NSTE-ACS and MVD. Major adverse cardiac events (MACE) were defined as death, myocardial infarction, or any revascularization. Results: During follow-up (median 36 months), MACE occurred in 96 patients (26.2%); 35 (19.6%) in the MVR group and 61 (32.6%) in the SVR group (P = 0.003). In multivariate analysis, MVR was associated with a lower incidence of MACE (hazard ratio [HR]: 0.50, 95% confidence interval [CI]: 0.30-0.85) and revascularization (HR: 0.43, 95% CI: 0.24-0.78), but not of death (HR: 0.69, 95% CI: 0.25-1.93) and myocardial infarction (HR: 0.39, 95% CI: 0.11-1.47). The incidence of periprocedural renal dysfunction was not significantly different between patients undergoing MVR vs SVR (3.4% vs 1.6%, P = 0.33). Definite or probable stent thrombosis occurred at a similar rate (2.2% in the MVR group and 2.7% in the SVR group, P = 0.99). Conclusions: In patients with NSTE-ACS and MVD, MVR using drug-eluting stents may reduce MACE. Our findings should be confirmed by a prospective, randomized trial.