Abstract：
BACKGROUND: Incomplete revascularization (ICR) has been associated with a worse prognosis after a percutaneous coronary intervention (PCI). In NSTEMI patients with multivessel disease (MVD) however, the benefit of a complete revascularization (CR) remains unclear.
METHODS: Patients presenting with an NSTEMI and MVD were selected from the global e-ULTIMASTER registry and grouped according to completeness of revascularization at index hospitalization discharge. The primary endpoint was the patient oriented composite endpoint (POCE) defined as all death, any myocardial infarction, and any revascularization at 1 year. Target lesion failure (TLF) was defined as the composite of cardiac death, target vessel related myocardial infarction and clinically driven target lesion revascularization. Inverse propensity score weighting (IPSW) was performed to harmonize the patient\'s baseline characteristics between the groups.
RESULTS: CR was achieved in 1800 patients (47.0 %) and ICR in 2032 patients (53.0 %). The incidence of POCE at 1 year was lower in the CR group compared to the ICR group: 7.0 % vs. 12.9 %, p < 0.0001. Similarly for TLF at 1 year: 3.6 % vs. 5.5 %, p < 0.01. After IPSW, the incidence of POCE was 7.7 % vs. 12.0 %, p < 0.0001, due to a lower all-cause mortality: 2.7 % vs. 4.2 %, p = 0.02 and less revascularizations: 4.9 % vs. 7.9 %, p < 0.001. The incidence of TLF was no longer statistically significant: CR 3.9 % vs. IR 5.0 %, p = 0.10.
CONCLUSIONS: Patients with a NSTEMI and multi vessel disease undergoing a percutaneous coronary revascularization with a complete revascularization during index hospitalization have better 1-year clinical outcomes. Randomized studies are warranted to confirm these results.
METHODS: Patients presenting with an NSTEMI and MVD were selected from the global e-ULTIMASTER registry and grouped according to completeness of revascularization at index hospitalization discharge. The primary endpoint was the patient oriented composite endpoint (POCE) defined as all death, any myocardial infarction, and any revascularization at 1 year. Target lesion failure (TLF) was defined as the composite of cardiac death, target vessel related myocardial infarction and clinically driven target lesion revascularization. Inverse propensity score weighting (IPSW) was performed to harmonize the patient\'s baseline characteristics between the groups.
RESULTS: CR was achieved in 1800 patients (47.0 %) and ICR in 2032 patients (53.0 %). The incidence of POCE at 1 year was lower in the CR group compared to the ICR group: 7.0 % vs. 12.9 %, p < 0.0001. Similarly for TLF at 1 year: 3.6 % vs. 5.5 %, p < 0.01. After IPSW, the incidence of POCE was 7.7 % vs. 12.0 %, p < 0.0001, due to a lower all-cause mortality: 2.7 % vs. 4.2 %, p = 0.02 and less revascularizations: 4.9 % vs. 7.9 %, p < 0.001. The incidence of TLF was no longer statistically significant: CR 3.9 % vs. IR 5.0 %, p = 0.10.
CONCLUSIONS: Patients with a NSTEMI and multi vessel disease undergoing a percutaneous coronary revascularization with a complete revascularization during index hospitalization have better 1-year clinical outcomes. Randomized studies are warranted to confirm these results.
摘要：
背景：不完全血运重建（ICR）与经皮冠状动脉介入治疗（PCI）后预后较差相关。然而，在患有多支血管疾病(MVD)的NSTEMI患者中，完全血运重建(CR)的益处尚不清楚.
方法：从全球e-ULTIMASTER注册表中选择患有NSTEMI和MVD的患者，并根据住院出院时血运重建的完整性进行分组。主要终点是面向患者的复合终点（POCE），定义为所有死亡，任何心肌梗塞,和1年后的任何血运重建。靶损伤失效(TLF)定义为心脏死亡的复合,靶血管相关心肌梗死和临床驱动的靶病变血运重建。进行反向倾向评分加权(IPSW)以协调组间患者的基线特征。
结果：1800例患者达到CR（47.0%），2032例患者达到ICR（53.0%）。与ICR组相比，CR组1年POCE的发生率较低：7.0％vs.12.9%,p<0.0001。TLF在1年时也是如此：3.6%与5.5%,p<0.01。在IPSW之后,POCE的发生率为7.7%vs.12.0%,p<0.0001，由于全因死亡率较低：2.7%vs.4.2%，p=0.02及以下血运重建：4.9%vs.7.9%，p<0.001。TLF的发生率不再具有统计学意义：CR3.9%vs.IR5.0%，p=0.10。
结论：患有NSTEMI和多血管疾病的患者在住院期间接受经皮冠状动脉血运重建和完全血运重建的1年临床结局更好。有必要进行随机研究以证实这些结果。
方法：从全球e-ULTIMASTER注册表中选择患有NSTEMI和MVD的患者，并根据住院出院时血运重建的完整性进行分组。主要终点是面向患者的复合终点（POCE），定义为所有死亡，任何心肌梗塞,和1年后的任何血运重建。靶损伤失效(TLF)定义为心脏死亡的复合,靶血管相关心肌梗死和临床驱动的靶病变血运重建。进行反向倾向评分加权(IPSW)以协调组间患者的基线特征。
结果：1800例患者达到CR（47.0%），2032例患者达到ICR（53.0%）。与ICR组相比，CR组1年POCE的发生率较低：7.0％vs.12.9%,p<0.0001。TLF在1年时也是如此：3.6%与5.5%,p<0.01。在IPSW之后,POCE的发生率为7.7%vs.12.0%,p<0.0001，由于全因死亡率较低：2.7%vs.4.2%，p=0.02及以下血运重建：4.9%vs.7.9%，p<0.001。TLF的发生率不再具有统计学意义：CR3.9%vs.IR5.0%，p=0.10。
结论：患有NSTEMI和多血管疾病的患者在住院期间接受经皮冠状动脉血运重建和完全血运重建的1年临床结局更好。有必要进行随机研究以证实这些结果。
