Two studies examine mortality risk of single- vs. multivessel PCI

Results from two studies published in EuroIntervention have shown that multivessel PCI was not associated with an increased mortality risk when compared with single-vessel PCI, and in one study, it was linked to a mortality reduction at 3 years.

In the first study, Onuma and colleagues aimed to determine whether intervention on stable chronic non-culprit lesions could prevent future events in a cohort of 990 consecutive patients with non-ST segment elevation ACS. The analysis included 379 patients who underwent single-vessel PCI and 611 patients who underwent multivessel intervention.

The investigators performed a propensity score matching analysis that included 230 patients with single-vessel intervention and 230 who received multivessel intervention.

Patients in the multivessel cohort experienced less treatment before intervention than those with single-vessel intervention and higher rates of MI and more complex lesions.

Three-year results indicated that all-cause mortality was 13% in the multivessel group and 18.3% in the single-vessel group (P=.02; adjusted HR=0.55). No differences were reported between the two groups regarding rates of target vessel revascularization and a composite of all-cause mortality or MI, according to the findings.

Results from the propensity-matched cohort indicated that multivessel intervention yielded significantly lower rates of all-cause death than single-vessel intervention (adjusted HR=0.41; 95% CI, 0.22-0.75).

The second study, conducted by Jaguszewski and colleagues, included 12,000 patients with STEMI who underwent PCI. The researchers aimed to determine which type of STEMI patients were more likely to undergo multivessel procedures, and whether those procedures yielded better or worse results than single-vessel intervention when the patient population was stratified according to risk.

Eligible participants had been enrolled in the Swiss AMIS Plus registry between 2005 and 2012. There were 4,941 individuals with multivessel disease. The investigators stratified patients with left main involvement (n=263), out-of-hospital cardiac arrest or Killip class III/IV as high risk. They observed associations between multivessel PCI and in-hospital mortality.

There were 1,108 patients who underwent multivessel PCI and 3,833 who underwent single-vessel intervention.

Multivessel intervention was used more frequently than single-vessel intervention in all three of the high-risk categories. For left main involvement, 14.5% of patients underwent multivessel PCI compared with 2.7% who underwent single-vessel intervention (P<.001). In the out-of-hospital cardiac arrest group, the rates were 8.6% for multivessel PCI and 5.9% for single-vessel intervention (P<.01). For Killip class III/IV patients, there were more multivessel interventions than single-vessel interventions (12.3% vs. 6.2%; P<.001).

In-hospital mortality rates were 7.3% after multivessel PCI and 4.4% after single-vessel intervention (P<.001). When patients were stratified by risk, the in-hospital mortality rates were the same for multivessel and single-vessel intervention. In the low-risk group, the rates were 2% for multivessel PCI and 2% for single-vessel PCI (P=1). In high-risk patients, the rates were 22.2% in the multivessel group and 21.7% in the single-vessel group (P=1).

“High-risk patients are more likely to undergo [multivessel] PCI,” Jaguszewski and colleagues concluded. “Furthermore, [multivessel] PCI does not appear to be associated with higher mortality after stratifying patients based on their risk.”

For more information:

Jaguszewski M. EuroIntervention. 2013;9:909-915.

Onuma Y. EuroIntervention. 2013;9:916-922.

Disclosure: The researchers of both studies report no relevant financial disclosures.