Culprit-only versus multivessel or complete versus incomplete revascularization in patients with non-ST-segment elevation myocardial infarction and multivessel disease who underwent successful percutaneous coronary intervention using newer-generation drug-eluting stents

Background and aims The long-term comparative results between culprit-only percutaneous coronary intervention (C–PCI) and multivessel PCI (M-PCI) or those between complete revascularization (CR) and incomplete revascularization (IR) in patients with non-ST-elevation myocardial infarction (NSTEMI) and multivessel disease (MVD) after successful newer-generation drug-eluting stent (DES) implantation are limited. Therefore, we compared the 2-year clinical outcomes in such patients. Methods A total of 4588 patients with NSTEMI and MVD (C–PCI, n = 2055; M-PCI, n = 2533; CR, n = 2029; IR, n = 504) were evaluated. The primary outcome was major adverse cardiac events (MACEs) defined as all-cause death, recurrent myocardial infarction MI, and any repeat coronary revascularization. The secondary outcome was stent thrombosis (ST). Results The cumulative incidences of the primary and secondary outcomes were similar in the three comparison groups (C–PCI vs. M-PCI, CR vs. IR, or CR vs. C–PCI). However, the cumulative incidence of non-target vessel revascularization (non-TVR) was higher in the C–PCI group than in the M-PCI group (adjusted hazard ratio [aHR]: 2.011; 95% confidence interval [CI]: 1.942–3.985; p = 0.012), higher in the IR group than in the CR group (aHR: 2.051; 95% CI: 1.216–4.183; p = 0.043), and higher in the C–PCI group than in the CR group (aHR: 2.099; 95% CI: 1.237–3.564; p = 0.006). Conclusions Regarding the higher cumulative incidence of non-TVR, M-PCI and CR were preferred compared to C–PCI or IR in patients with NSTEMI and MVD. However, further randomized studies are required to confirm these findings.