Total versus staged versus functional revascularization in NSTEACS patients with multivessel disease

• Published in: The Egyptian heart journal Vol. 73; no. 1; p. 56
• Main Authors: Elkady, Ahmed O., Abdelghany, Mohamed, Diab, Reda, Ezz, Ahmed, Elagha, Abdalla A.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 26-06-2021; Springer; Springer Nature B.V; SpringerOpen
• Subjects: Acute coronary syndrome (ACS); Acute coronary syndromes; Angina pectoris; Angiography; Cardiac patients; Cardiology; Cardiovascular disease; Coronary artery bypass; Coronary heart disease; Coronary vessels; Family medical history; Fractional flow reserve (FFR); Health aspects; Heart; Heart attacks; Heart surgery; Management decisions; Medical imaging; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Non-ST segment elevation acute coronary syndrome (NSTEACS); Patients; Thrombosis; Vein & artery diseases; Fractional flow reserve (FFR); Acute coronary syndrome (ACS); Non-ST segment elevation acute coronary syndrome (NSTEACS)
• ISSN: 2090-911X; 1110-2608; 2090-911X
• DOI: 10.1186/s43044-021-00179-0

Background
The optimal strategy for revascularization in patients with NSTEACS who had multivessel coronary artery disease. A lack of evidence exists about the role of complete coronary revascularization by PCI in patients with non-ST segment elevation acute coronary syndrome (NSTEACS). Till now, ACC/AHA and ESC guidelines are not clear regarding the optimal strategy for revascularization in NSTEACS patients with multivessel coronary artery disease. In this setting, identification of the culprit lesion by angiography only could be challenging. The objective is to compare the hospital and short-term (6 months) outcomes of 3 different coronary revascularization strategies in NSTEACS patients with and multivessel coronary artery disease.
Results
Our study was a prospective study that included 90 patients who presented with acute chest pain and were diagnosed with NSTEACS. The patients were divided into 3 groups according to the plan of management: total revascularization group (total group), staged revascularization group (staged group), and functional revascularization group using FFR (FFR group). We studied the effect of demographic data, risk factors, and angiographic and procedural criteria on hospital and short-term outcomes. No significant statistical difference was seen among the three groups regarding the hospital outcome (in-stent thrombosis, unstable angina, and renal impairment). Also, the short-term (after 6 months) outcome regarding myocardial infarction, hospitalization, stroke, and cardiac death did not differ significantly between the three groups.
Conclusions
Considering NSTEACS patients with multivessel disease, different coronary revascularization strategies (total, staged, or FFR) are comparable regarding immediate and short-term (6 months) clinical follow-up. FFR can change the preplanned management, and less number of stents per patient is needed when FFR is utilized.