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Coronary artery disease
Original research article
Single-session versus staged procedures for elective multivessel percutaneous coronary intervention
  1. Toshiaki Toyota1,
  2. Takeshi Morimoto2,
  3. Hiroki Shiomi1,
  4. Kyohei Yamaji3,
  5. Kenji Ando3,
  6. Koh Ono1,
  7. Satoshi Shizuta1,
  8. Naritatsu Saito1,
  9. Takao Kato1,
  10. Shuichiro Kaji4,
  11. Yutaka Furukawa4,
  12. Yoshihisa Nakagawa5,
  13. Kazushige Kadota6,
  14. Minoru Horie7,
  15. Takeshi Kimura1
  16. CREDO-Kyoto PCI/CABG Registry Cohort-2 Investigators
  1. 1Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
  2. 2Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
  3. 3Division of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
  4. 4Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
  5. 5Division of Cardiology, Tenri Hospital, Tenri, Japan
  6. 6Division of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
  7. 7Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Ostu, Japan
  1. Correspondence to Professor Takeshi Kimura, Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin-kawaharacho, Sakyo-ku, Kyoto 606-8507, Japan; taketaka{at}kuhp.kyoto-u.ac.jp

Abstract

Objectives To clarify the effect of single-session multivessel percutaneous coronary intervention (PCI) strategy relative to the staged multivessel strategy on clinical outcomes in patients with stable coronary artery disease (CAD) or non-ST-elevation acute coronary syndrome.

Methods In the Coronary REvascularisation Demonstrating Outcome Study in Kyoto PCI/coronary artery bypass grafting registry cohort-2, there were 2018 patients who underwent elective multivessel PCI. Primary outcome measure was composite of all-cause death, myocardial infarction and stroke at 5-year follow-up.

Results Single-session multivessel PCI and staged multivessel PCI were performed in 707 patients (35.0%) and 1311 patients (65.0%), respectively. The cumulative 5-year incidence of and adjusted risk for the primary outcome measure were not significantly different between the single-session and staged groups (26.7% vs 23.0%, p=0.45; HR 0.91, 95% CI 0.72 to 1.16, p=0.47). The 30-day incidence of all-cause death was significantly higher in the single-session group than in the staged group (1.1% vs 0.2%, p=0.009). However, the causes of death in 11 patients who died within 30 days were generally not related to the procedural complications, but related to the serious clinical status before PCI. For the subgroup analyses including age, gender, extent of CAD, severe chronic kidney disease and heart failure, there was no significant interaction between the subgroup factors and the effect of the single-session strategy relative to the staged strategy for the primary outcome measure.

Conclusions The single-session multivessel PCI strategy was associated with at least comparable 5-year clinical outcomes compared with the staged multivessel PCI, although the prevalence of the single-session strategy was low in the present study.

  • percutaneous coronary intervention
  • coronary artery disease

https://doi.org/10.1136/heartjnl-2017-312117

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    Footnotes

    • Contributors TK had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Conception or design: TT, TM, HS, KY, KA, KO, SS, NS, TK, SK, YF, YN, KK, MH and TK. Acquisition, analysis or interpretation of data: TT, TM and TK. Drafting of the manuscript: TT and TK. Critical revision of the manuscript for important intellectual content: TT, TM, HS, KY, KA, KO, SS, NS, TK, SK, YF, YN, KK, MH and TK. Statistical analysis: TT and TM. Obtaining funding: TK. Administrative, technical or material support: TM and TK. Supervision: TT, TM, HS, KY, KA, KO, SS, NS, TK, SK, YF, YN, KK, MH and TK.

    • Funding This study was funded by the Pharmaceuticals and Medical Devices Agency in Japan. The funder had no role in the design and conduct of the study, in the collection, analysis and interpretation of the data, and in the preparation, review or approval of the manuscript.

    • Competing interests All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf anddeclare: TM received educational consultant fee from Boston Scientific Corporation for the past 36 months. No other financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work.

    • Ethics approval The protocol for the study was approved by the human research ethics committees of the Kyoto University Graduate School of Medicine.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Collaborators Membership of the CREDO-Kyoto PCI/CABG Registry Cohort-2 Investigators is provided in the eAppendix 1.