番茄社区

A single trip to the cath lab may be safer for patients undergoing complete coronary revascularization for multi-vessel disease, a small randomized study found.

Major adverse events within a year of follow-up -- such as death, reinfarction, target vessel revascularization, and stroke -- were 45% less common for single-stage percutaneous coronary intervention (PCI) recipients, at a rate of 13.63% versus 23.19% after multi-stage PCI.

This significant difference was driven by a lower rate of target vessel revascularization (8.33% versus 15.20%, hazard ratio 0.522, 95% confidence interval 0.310-0.878), Gennaro Sardella, MD, of Policlinico Umberto I University in Rome, and colleagues reported in the Jan. 26 issue of the .

As for the reason why that might be, Sardella and colleagues noted that patients who received PCI over multiple visits had a higher rate of 6-month stress testing during the follow-up period (35.36% versus 26.89% in single-stage PCI, P=0.0479).

Cardiac death and myocardial infarction odds were similar between groups in the SMILE trial, which randomized 584 patients to a single-stage or multi-stage revascularization.

Although guidelines suggest complete coronary revascularization of patients with non-ST-segment elevation myocardial infarction (NSTEMI) as acceptable in some cases of multivessel coronary artery disease, these do not currently provide clear recommendations for whether the percutaneous coronary intervention (PCI) should be completed in one shot.

While the researchers had hypothesized that longer procedure duration and higher contrast volumes with a single-stage approach might hurt long-term outcomes, they concluded: "On the basis of near-term outcomes in patients with NSTEMI and multi-vessel coronary artery disease, single-session complete coronary interventional procedures are preferred over multistage methods."

In an accompanying editorial,, and , both of University of Amsterdam in The Netherlands, expressed surprise at the results. They cautioned that "when interpreting SMILE, one may find a reason to frown," given its lack of data on whether repeat revascularization was for in-stent restenosis or a new lesion; the kind of repeat revascularization performed; and whether invasive or noninvasive testing for ischemia was used.

Nonetheless, "the unexpected and unexplained finding of increased target vessel revascularization with multi-stage complete revascularization deserves further attention," they concluded.