• Yoshinobu Onuma, Takashi Muramatsu, Chrysafios Girasis, Neville Kukreja, Hector M Garcia-Garcia, Joost Daemen, Nieves Gonzalo, Nicolo Piazza, Jannet Einthoven, Ron van Domburg, Patrick W Serruys, and interventional cardiologists of the Thoraxcenter (2000-5).
• Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
• EuroIntervention. 2013 Dec 1; 9 (8): 916-22.

AimsCoronary artery disease is often diffuse and patients with non-ST-segment acute coronary syndromes (NSTE-ACS) demonstrate multivessel coronary disease. The purpose of this study was to clarify whether interventions on stable chronic non-culprit lesions in patients with NSTE-ACS can prevent future adverse events.Methods And ResultsWe performed a retrospective cohort study of 990 consecutive patients who underwent either single-vessel PCI (SVPCI: n=379) or multivessel PCI (MVPCI: n=611) in a setting of NSTE-ACS. Cox proportional hazards regression analysis was performed to compensate for differences in baseline characteristics between the groups. To minimise the impact of confounding factors, we performed propensity matching (SVPCI: n=230, MVPCI: n=230). Patients who had MVPCI had a lower rate of prior interventional treatment or myocardial infarction, and more complex lesions than patients with SVPCI. At three years, all-cause mortality was significantly lower in the MVPCI group than the SVPCI group (13.0% vs. 18.3%, p=0.02, adjusted HR 0.55, 95% CI: 0.38-0.80), while the rates of target vessel revascularisation and a composite of all-cause death or myocardial infarction were not different between the groups. In the propensity-matched cohort, all-cause death remained significantly lower in the MVPCI group (adjusted HR 0.41, 95% CI: 0.22-0.75) compared to the SVPCI group.ConclusionsIn this retrospective study, multivessel PCI reduced all-cause mortality in a setting of NSTE-ACS compared to single-vessel PCI. Further investigations to confirm these results are warranted.

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