BackgroundComplete revascularization reduces cardiovascular events in patients with acute coronary syndromes (ACSs) and multivessel disease. The optimal time point of non–target‐vessel percutaneous coronary intervention (PCI) remains a matter of debate. The aim of this study was to investigate the impact of early (<4 weeks) versus late (≥4 weeks) staged PCI of non–target‐vessels in patients with ACS scheduled for staged PCI after hospital discharge.Methods and ResultsAll patients with ACS undergoing planned staged PCI from 2009 to 2017 at Bern University Hospital, Switzerland, were analyzed. Patients with cardiogenic shock, in‐hospital staged PCI, staged cardiac surgery, and multiple staged PCIs were excluded. The primary end point was all‐cause death, recurrent myocardial infarction and urgent premature non–target‐vessel PCI. Of 8657 patients with ACS, staged revascularization was planned in 1764 patients, of whom 1432 patients fulfilled the eligibility criteria. At 1 year, there were no significant differences in the crude or adjusted rates of the primary end point (7.8% early versus 10.8% late, hazard ratio [HR], 0.72 [95% CI, 0.47–1.10], P=0.129; adjusted HR, 0.80 [95% CI, 0.50–1.28], P=0.346) and its individual components (all‐cause death: 1.5% versus 2.9%, HR, 0.52 [95% CI, 0.20–1.33], P=0.170; adjusted HR, 0.62 [95% CI, 0.23–1.67], P=0.343; recurrent myocardial infarction: 4.2% versus 4.4%, HR, 0.97 [95% CI, 0.475–1.10], P=0.924; adjusted HR, 1.03 [95% CI, 0.53–2.01], P=0.935; non–target‐vessel PCI, 3.9% versus 5.7%, HR, 0.97 [95% CI, 0.53–1.80], P=0.928; adjusted HR, 1.19 [95% CI, 0.61–2.34], P=0.609).ConclusionsIn this single‐center cohort study of patients with ACS scheduled to undergo staged PCI after hospital discharge, early (<4 weeks) versus late (≥4 weeks) staged PCI was associated with a similar rate of major adverse cardiac events at 1 year follow‐up.RegistrationURL: https://www.clinicaltrials.gov; Unique identifier: NCT02241291.

中文翻译：

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分期经皮冠状动脉介入治疗时机对急性冠状动脉综合征患者临床结局的影响

背景完全血运重建可减少急性冠状动脉综合征 (ACS) 和多支血管疾病患者的心血管事件。非靶血管经皮冠状动脉介入治疗（PCI）的最佳时间点仍然存在争议。本研究的目的是调查在出院后计划进行分期 PCI 的 ACS 患者中，早期（<4 周）与晚期（≥4 周）非靶血管分期 PCI 的影响。方法和结果所有 ACS 患者分析了 2009 年至 2017 年在瑞士伯尔尼大学医院进行的计划分期 PCI。排除心源性休克、院内分期 PCI、分期心脏手术和多期 PCI 的患者。主要终点是全因死亡、复发性心肌梗死和紧急过早的非靶血管 PCI。在 8657 名 ACS 患者中，1764 名患者计划进行分期血运重建，其中 1432 名患者符合入选标准。1 年时，主要终点的粗略或调整率没有显着差异（早期 7.8% 和晚期 10.8%，风险比 [HR]，0.72 [95% CI，0.47–1.10]，P = 0.129；调整后的 HR，0.80 [95% CI，0.50–1.28]，P = 0.346）及其各个组成部分（全因死亡：1.5% 对 2.9%，HR，0.52 [95% CI，0.20–1.33]，P = 0.170 ；调整后的 HR，0.62 [95% CI，0.23–1.67]，P = 0.343；复发性心肌梗死：4.2% 对 4.4%，HR，0.97 [95% CI，0.475–1.10]，P = 0.924；调整后的 HR，1.03 [95% CI，0.53–2.01]，P = 0.935；非靶血管 PCI，3.9% 对 5.7%，HR，0.97 [95% CI，0.53–1.80]，P = 0.928；调整后 HR，1.19 [95 % CI, 0.61–2.34], P=0.609)。结论在这项针对计划在出院后接受分期 PCI 的 ACS 患者的单中心队列研究中，早期（<4 周）与晚期（≥4 周）分期 PCI 与主要不良心脏事件的发生率相似1 年随访。注册网址：https://www.clinicaltrials.gov；唯一标识符：NCT02241291。