Turk Kardiyol Dern Ars. 2025; 53(2): 93-99 | DOI: 10.5543/tkda.2024.59839

Ten-Year Outcomes Following Revascularization Strategies for Non-ST-Segment Elevation Myocardial Infarction and Multivessel Disease

Aykut Demirkıran, Cihan Aydın, Aydın Akyüz, Şeref Alpsoy
Department of Cardiology, Tekirdag Namık Kemal University, Tekirdağ, Turkiye

OBJECTIVE
There remain conflicting recommendations regarding revascularization strategies for patients with non-ST-segment elevation myocardial infarction (NSTEMI) and multivessel disease (MVD). This study aimed to compare the long-term outcomes of different revascularization strategies.

METHOD
Patients with similar characteristics were categorized into three groups: immediate complete revascularization (ICR), staged complete revascularization (SCR), and non-complete revascularization (NCR). The SCR group was further divided based on the time interval between the index and staged procedures: SCR ≤ 24 hours and SCR > 24 hours. Cardiac composite outcomes included the total number of cardiac deaths and recurrent myocardial infarction during the follow-up period.

RESULTS
Out of 14,511 screened patients, 316 were included in the analysis. The results showed a significant difference in risk between SCR and ICR (hazard ratio [HR] (95% confidence interval [CI]): 0.27 (0.15-0.47); P = 0.001). There was no significant difference between NCR and SCR (HR (95% CI): 1.06 (0.61-1.84); P = 0.832). The SCR group was divided into two groups based on the time interval from the first to the second procedure (time interval [TI] ≤ 24 hours in the SCR1 group, and TI > 24 hours in the SCR2 group). The frequency of cardiac composite outcomes was lower in SCR1 compared to SCR2 (16.7% vs. 47.1%; P = 0.038).

CONCLUSION
Our findings support the use of ICR and SCR completed within 24 hours due to their favorable long-term outcomes in patients with MVD and NSTEMI.

Keywords: Complete revascularization, infarct-related artery, multivessel disease, revascularization strategies, non-ST-segment elevation myocardial infarction

---

CITE