Impact of stenting long lesions on clinical outcomes in patients presenting with acute coronary syndrome and multivessel disease: data from the BIOVASC trial.

An increased total stent length (TSL) might be associated with a higher risk of clinical events, however, in patients with multivessel disease (MVD) a considerable total stent length is often required. In patients presenting with acute coronary syndrome (ACS) and MVD, immediate complete revascularization was associated with shorter TSL in the BIOVASC Trial. This is a sub-analysis of the BIOVASC trial comparing clinical outcomes in patients with either <60mm or ≥60mm total stent length. The primary outcome was a composite of all-cause mortality, myocardial infarction, any unplanned ischemia driven revascularization or cerebrovascular events at 2 years post index procedure. 1525 patients were enrolled in the BIOVASC trial, of whom 855 had a TSL of ≥60mm (long TSL). No significant difference was established when comparing patients treated with either long or short TSL in terms of the primary outcome at 2-year follow up, which occurred in 117 patients (13.7%) in the ≥60 mm group and 69 patients (10.3%) in the <60mm group (adjusted HR 1.25, 95% CI 0.92-1.69, p=0.16). Also, no significant differences were observed in the secondary endpoints. In conclusion, in patients with ACS and MVD, long stenting did not show a significant difference in clinical event rate compared with short stenting.

Propensity Matched Comparison of Clinical Outcome After Immediate Versus Staged Complete Revascularization in Patients With Acute Coronary Syndrome and Multivessel Disease.

Complete revascularization (CR) in patients with acute coronary syndromes (ACS) and multivessel disease (MVD) improves clinical outcomes compared with culprit-only revascularization, but the optimal timing for non-culprit lesions treatment remains unclear. This study evaluated patients presenting with ACS and MVD admitted between January 2015 and September 2021 at the Erasmus University Medical Center. Clinical outcomes were compared between immediate and staged CR in terms of major adverse cardiac and cerebrovascular events (MACCEs), a composite of all-cause mortality, myocardial infarction, stroke, and any unplanned revascularization. A total of 1,400 patients presenting with ACS and MVD who underwent immediate or staged CR were included in this study. Using 1/many propensity score matching without replacement, 299 patients in the staged CR group were matched to 598 patients in the immediate CR group (mean 1:2 ratio), rendering a total of 897 patients for analysis. The median follow-up period was 648 days. MACCE rate was significantly higher in the staged CR group than in the immediate CR group (adjusted hazard ratio [95% confidence interval] 1.60 [1.05 to 2.45], p = 0.03). Furthermore, number of stents, stent length, and contrast usage were significantly greater in the staged revascularization group. Immediate CR was associated with less risk of MACCE than was staged CR. Staged CR required overall more contrast and stent material.