Complete revascularization likely improves HF risk in those with ACS plus multivessel CAD
Key takeaways:
- Complete revascularization may reduce HF hospitalization and mortality in patients with ACS and multivessel CAD.
- The benefits were consistent across different ACS presentations.
Complete revascularization was associated with reduced HF hospitalization and both CV and all-cause death among patients presenting with ACS and multivessel CAD, researchers reported in the Journal of the American Heart Association.
“The physiopathological benefit of complete revascularization for STEMI and potentially non-ST-elevation ACS on improved survival relies on the prevention of recurrent events due to nonculprit lesions, although potentially the improvement of left ventricular ejection fraction after complete revascularization may lead to a reduced development of incident HF,” Francesco Bruno, MD, of the division of cardiology at “Città della Salute e della Scienza di Torino” Hospital and the department of medical sciences at the University of Turin, Italy, and colleagues wrote. “However, the impact of complete revascularization on the incidence of HF during the follow-up after ACS and its impact on survival has not been investigated so far.”
Image: Adobe Stock
Bruno and colleagues used the Incidence and Predictors of Heart Failure After Acute Coronary Syndrome (CORALYS) registry to evaluate the impact of complete revascularization on adverse outcome among 5,054 consecutive patients with ACS and multivessel CAD who underwent PCI.
The primary endpoint was incidence of first HF hospitalization or CV death.
Overall, 29.2% of patients underwent complete revascularization.
The researcher observed that patients who received complete revascularization were more often younger (mean age, 66.4 vs. 67.3 years; P = .004) and less often women (22.5% vs. 28.8%; P < .001). In addition, those who underwent complete revascularization had a lower prevalence of hypertension (67% vs. 77.5%; P < .001), diabetes (27% vs. 35.5%; P < .001), dyslipidemia (49.4% vs. 65.1%; P < .001), previous MI (19.6% vs. 31.4%; P < .001), previous PCI (19.8% vs. 32.2%; P < .001) or surgical revascularization (5.6% vs. 18.6%; P < .001).
During 5 years of follow-up, complete revascularization was associated with reduced incidence of the following:
- the primary endpoint (adjusted HR = 0.66; 95% CI, 0.51-0.85);
- first HF hospitalization (aHR = 0.67; 95% CI, 0.49-0.9);
- CV death (aHR = 0.56; 95% CI, 0.38-0.84); and
- all-cause death (aHR = 0.74; 95% CI, 0.56-0.97).
Moreover, the observed benefit from complete revascularization was consistent among patients who presented with STEMI (HR = 0.59; 95% CI, 0.39-0.89), non-ST-elevation ACS (HR = 0.71; 95% CI, 0.5-0.99) and those with LVEF more than 40% (HR = 0.52; 95% CI, 0.37-0.72). No benefit was observed among patients with LVEF of 40% or lower (HR = 0.77; 95% CI, 0.37-1.1; P for interaction = .04).
“In patients with ACS ... and multivessel disease, complete revascularization reduced the risk of first hospitalization for heart failure and cardiovascular death, as well as first HF hospitalization, and cardiovascular and overall death,” the researchers wrote. “Complete revascularization should be performed in all patients with ACS to reduce the incidence of HF and death at follow-up. ... However, further evidence is needed among patients with reduced left ventricular ejection fraction.”
Collapse