- In patients with multivessel coronary artery disease (CAD), staged percutaneous coronary intervention (PCI) is associated with lower mortality than one-time (OT) multivessel revascularization (MVR).
- Staged-PCI rates vary by site for unclear reasons.
- Randomized trial is needed.
Why this matters
- The best timing for multivessel revascularization remains unclear.
- 36.1% underwent staged PCI; 63.9% underwent OTMVR.
- Staged PCI likelier if patient had chronic kidney disease, 3- vs 2-vessel disease, ST-segment elevation myocardial infarction (STEMI).
- It was also, as expected, likelier at high- vs low-likelihood sites (OR, 0.20-5.08).
- All-cause mortality with staged PCI vs OTMVR (median follow-up, 43.7 months) (HRs; 95% CIs):
- All comers, with propensity-score adjustment: 0.78 (0.72-0.84; P<.01>
- Acute coronary syndrome, adjusted: 0.73 (0.66-0.81; P<.01>
- STEMI: 0.31 (0.21-0.47; P<.01>
- Non-STEMI: 0.74 (0.64-0.87; P<.01>
- Unstable angina: 0.75 (0.64-0.89; P<.01>
- Stable angina: 0.88 (0.77-1.00; P=.048).
- Analysis of Veterans Affairs Clinical Assessment, Reporting, and Tracking Program.
- Participants at 61 sites had undergone PCI of >2 vessels (n=7599).
- Authors used propensity matching to compare mortality with staged PCI vs OTMVR.
- Funding: Authors disclose industry, nonprofit, government funding.
- Observational data; unmeasured confounders.