Introduction: There are only a few studies comparing the single-session versus staged multi-vessel percutaneous coronary intervention (PCI) procedures in patients with stable coronary artery disease (CAD) or non-ST-elevation acute coronary syndrome. Hypothesis: We sought to clarify the effect of single-session multi-vessel PCI strategy relative to the staged multi-vessel strategy on clinical outcomes in patients with stable CAD or non-ST-elevation acute coronary syndrome.
Methods: Among 15939 patients included in the CREDO-Kyoto PCI/CABG registry cohort-2, there were 2018 patients who underwent elective multi-vessel PCI for stable CAD or non-ST-segment elevation acute coronary syndrome. The primary outcome measure was composite of all-cause death, myocardial infarction, and stroke during 5-year follow-up. Subgroup analyses were performed according to the age, gender, presence of triple vessel disease or left main coronary artery disease, severe chronic kidney disease, and heart failure.
Results: Single-session multi-vessel PCI and staged multi-vessel 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% versus 23.0%, P=0.45; adjusted HR: 0.91, 95%CI: 0.72-1.16, 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% versus 0.2%, P=0.009), however, the causes of death who died within 30-day were generally not related to the procedural complications, but related to the serious clinical status before PCI. The incidence of contrast induced nephropathy was not significantly different between the two groups. For the subgroup analyses, 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 multi-vessel PCI strategy was associated with at least comparable 5-year clinical outcomes compared with the staged multi-vessel PCI, although the prevalence of the single-session strategy was low in the present study.