Optimal revascularization strategy in patients with acute coronary syndrome and multivessel disease: insights from a network meta-analysis.
Andrea Milzi, Stefano Benenati, Antonio Landi et al.
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In 30 seconds
This network meta-analysis compared culprit-only revascularization with angiography-guided and physiology-guided complete revascularization in patients with acute coronary syndrome and multivessel disease. It included 14 randomized trials and 11,871 participants. Compared with culprit-only treatment, both complete-revascularization strategies were associated with fewer major adverse cardiac events: IRR 0.60 (95%-CI 0.46-0.79) for angiography guidance and IRR 0.65 (95%-CI 0.50-0.85) for physiology guidance. The strategies were considered comparable for preventing future events; mortality estimates did not establish a clear difference.
Key findings
- Angiography-guided complete revascularization reduced MACE versus culprit-only treatment (IRR 0.60, 95%-CI 0.46-0.79).
- Physiology-guided complete revascularization reduced MACE versus culprit-only treatment (IRR 0.65, 95%-CI 0.50-0.85).
- All-cause and cardiovascular mortality estimates versus culprit-only treatment had confidence intervals that included no difference for both complete-revascularization strategies.
Why it matters
The analysis addresses whether treating non-culprit lesions in ACS with multivessel disease is associated with better outcomes, and whether lesion selection by angiography or physiology changes that benefit. Its findings support attention to complete revascularization for reducing MACE, while the lack of a clear distinction between guidance strategies and uncertain mortality estimates temper conclusions about the preferred approach.
What to keep in mind
The abstract does not report further limitations; the findings are based on a network meta-analysis of randomized trials, and mortality estimates remain imprecise.