Heart and Vessels

, Volume 34, Issue 2, pp 251–258 | Cite as

Complete and incomplete revascularization in non-ST segment myocardial infarction with multivessel disease: long-term outcomes of first- and second-generation drug-eluting stents

  • Ming-Jer Hsieh
  • Chun-Chi Chen
  • Cheng-Hung Lee
  • Chao-Yung Wang
  • Shang-Hung Chang
  • Dong-Yi Chen
  • Chia-Hung Yang
  • Ming-Lung Tsai
  • Jih-Kai Yeh
  • Ming-Yun Ho
  • I-Chang HsiehEmail author
Original Article


The therapeutic effects of reperfusion strategies with complete revascularization (CR) or incomplete revascularization (IR) in non-ST segment myocardial infarction (NSTEMI) patients with multivessel disease (MVD) are controversial. In such patients, whether utilization of different generations of drug-eluting stents (DES) for IR or CR affect long-term major adverse cardiovascular events (MACE) is unknown. This study included 702 NSTEMI patients with MVD who received first-generation (1G) or second-generation (2G) DES. In multivariable analysis, chronic kidney disease, chronic total, 1G DES and IR were independent predictors of long-term MACE. In patients receiving 1G DES, no significant differences of MACE were observed between the IR and CR groups (39.1% vs. 36.2%, p = 0.854). However, in patients receiving 2G DES, significantly fewer MACE were observed in the CR group than in the IR group (3.7% vs. 10.2%, p = 0.002). Compared with patients receiving 1G DES for IR, those receiving 2G DES for IR and CR exhibited significantly lower risk of MACE (59% and 83% lower, respectively). CR could not provide clinical benefits over IR in NSTEMI patients with MVD receiving 1G DES. However, in patients receiving 2G DES, compared with IR, CR was associated with a lower risk of long-term MACE, which was mainly caused by low rates of non-TLR and any revascularization.


Complete revascularization First generation Second generation Drug-eluting stents Non-ST segment myocardial infarction 



This work was supported by Chang Gung Medical Foundation, Grant no. CORPG 3C0162 & 3G0281.

Compliance with ethical standards

Conflict of interest

The author(s) declare that they have no competing interests.


  1. 1.
    Breeman A, Mercado N, Lenzen M, van den Brand MM, Harrington RA, Califf RM, Topol EJ, Simoons ML, Boersma E, Investigators P (2002) Characteristics, treatment and outcome of patients with non-ST-elevation acute coronary syndromes and multivessel coronary artery disease: observations from PURSUIT (platelet glycoprotein IIb/IIIa in unstable angina: receptor suppression using integrelin therapy). Cardiology 98:195–201CrossRefGoogle Scholar
  2. 2.
    Authors/Task Force m, Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V, Filippatos G, Hamm C, Head SJ, Juni P, Kappetein AP, Kastrati A, Knuuti J, Landmesser U, Laufer G, Neumann FJ, Richter DJ, Schauerte P, Sousa Uva M, Stefanini GG, Taggart DP, Torracca L, Valgimigli M, Wijns W, Witkowski A (2014) 2014 ESC/EACTS Guidelines on myocardial revascularization: the Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J 35:2541–2619CrossRefGoogle Scholar
  3. 3.
    Fihn SD, Blankenship JC, Alexander KP, Bittl JA, Byrne JG, Fletcher BJ, Fonarow GC, Lange RA, Levine GN, Maddox TM, Naidu SS, Ohman EM, Smith PK (2014) 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 64:1929–1949CrossRefGoogle Scholar
  4. 4.
    Pandey A, McGuire DK, de Lemos JA, Das SR, Berry JD, Brilakis ES, Banerjee S, Marso SP, Barsness GW, Simon DN, Roe M, Goyal A, Kosiborod M, Amsterdam EA, Kumbhani DJ (2016) Revascularization trends in patients with diabetes mellitus and multivessel coronary artery disease presenting with non-ST elevation myocardial infarction: insights from the national cardiovascular data registry acute coronary treatment and intervention outcomes network registry-get with the guidelines (NCDR ACTION Registry-GWTG). Circ Cardiovasc Qual Outcomes 9:197–205CrossRefGoogle Scholar
  5. 5.
    Ahn JM, Park DW, Lee CW, Chang M, Cavalcante R, Sotomi Y, Onuma Y, Tenekecioglu E, Han M, Lee PH, Kang SJ, Lee SW, Kim YH, Park SW, Serruys PW, Park SJ (2017) Comparison of stenting versus bypass surgery according to the completeness of revascularization in severe coronary artery disease: patient-level pooled analysis of the SYNTAX, PRECOMBAT, and BEST trials. JACC Cardiovasc Interv 10:1415–1424CrossRefGoogle Scholar
  6. 6.
    Brener SJ, Murphy SA, Gibson CM, DiBattiste PM, Demopoulos LA, Cannon CP, Aggrastat T-TITAw, Determine Cost of Therapy with an Invasive or Conservative Strategy-Thrombosis in Myocardial I (2002) Efficacy and safety of multivessel percutaneous revascularization and tirofiban therapy in patients with acute coronary syndromes. Am J Cardiol 90:631–633CrossRefGoogle Scholar
  7. 7.
    Palmer ND, Causer JP, Ramsdale DR, Perry RA (2004) Effect of completeness of revascularization on clinical outcome in patients with multivessel disease presenting with unstable angina who undergo percutaneous coronary intervention. J Invasive Cardiol 16:185–188Google Scholar
  8. 8.
    Kim MC, Jeong MH, Ahn Y, Kim JH, Chae SC, Kim YJ, Hur SH, Seong IW, Hong TJ, Choi DH, Cho MC, Kim CJ, Seung KB, Chung WS, Jang YS, Cho SY, Rha SW, Bae JH, Cho JG, Park SJ, Korea Acute Myocardial Infarction Registry I (2011) What is optimal revascularization strategy in patients with multivessel coronary artery disease in non-ST-elevation myocardial infarction? Multivessel or culprit-only revascularization. Int J Cardiol 153:148–153CrossRefGoogle Scholar
  9. 9.
    Lee HJ, Song YB, Hahn JY, Kim SM, Yang JH, Choi JH, Choi SH, Choi JH, Lee SH, Gwon HC (2011) Multivessel vs single-vessel revascularization in patients with non-ST-segment elevation acute coronary syndrome and multivessel disease in the drug-eluting stent era. Clin Cardiol 34:160–165CrossRefGoogle Scholar
  10. 10.
    Onuma Y, Muramatsu T, Girasis C, Kukreja N, Garcia-Garcia HM, Daemen J, Gonzalo N, Piazza N, Einthoven J, van Domburg R, Serruys PW, Interventional cardiologists of the T (2013) Single-vessel or multivessel PCI in patients with multivessel disease presenting with non-ST-elevation acute coronary syndromes. EuroIntervention 9:916–922CrossRefGoogle Scholar
  11. 11.
    Hassanin A, Brener SJ, Lansky AJ, Xu K, Stone GW (2015) Prognostic impact of multivessel versus culprit vessel only percutaneous intervention for patients with multivessel coronary artery disease presenting with acute coronary syndrome. EuroIntervention 11:293–300CrossRefGoogle Scholar
  12. 12.
    Mariani J, Macchia A, De Abreu M, Gonzalez Villa Monte G, Tajer C (2016) Multivessel versus single vessel angioplasty in non-ST elevation acute coronary syndromes: a systematic review and metaanalysis. PLoS One 11:e0148756CrossRefGoogle Scholar
  13. 13.
    De Luca G, Smits P, Hofma SH, Di Lorenzo E, Vlachojannis GJ, Van’t Hof AWJ, van Boven AJ, Kedhi E, Stone GW, Suryapranata H, Drug-Eluting Stent in Primary Angioplasty c (2017) Everolimus eluting stent vs first generation drug-eluting stent in primary angioplasty: a pooled patient-level meta-analysis of randomized trials. Int J Cardiol 244:121–127CrossRefGoogle Scholar
  14. 14.
    Stone GW, Midei M, Newman W, Sanz M, Hermiller JB, Williams J, Farhat N, Caputo R, Xenopoulos N, Applegate R, Gordon P, White RM, Sudhir K, Cutlip DE, Petersen JL, Investigators SI (2009) Randomized comparison of everolimus-eluting and paclitaxel-eluting stents: two-year clinical follow-up from the Clinical Evaluation of the Xience V Everolimus Eluting Coronary Stent System in the Treatment of Patients with de novo Native Coronary Artery Lesions (SPIRIT) III trial. Circulation 119:680–686CrossRefGoogle Scholar
  15. 15.
    Varenhorst C, Lindholm M, Sarno G, Olivecrona G, Jensen U, Nilsson J, Carlsson J, James S, Lagerqvist B (2018) Stent thrombosis rates the first year and beyond with new- and old-generation drug-eluting stents compared to bare metal stents. Clin Res Cardiol 107(9):816–823CrossRefGoogle Scholar
  16. 16.
    Rodriguez AE, Santaera O, Larribau M, Sarmiento R, Haiek C, Del Pozo JF, Pavlovsky H, Rodriguez-Granillo AM, Investigators EI (2017) Second vs. first-generation drug-eluting stents in complex lesions subsets: 3 years’ follow-up of ERACI IV study. Miner Cardioangiol 65:81–90Google Scholar
  17. 17.
    Wanha W, Kawecki D, Roleder T, Morawiec B, Gladysz S, Kowalowka A, Jadczyk T, Adamus B, Pawlowski T, Smolka G, Kazmierski M, Ochala A, Nowalany-Kozielska E, Wojakowski W (2017) Second-generation drug-eluting stents in the elderly patients with acute coronary syndrome: the in-hospital and 12-month follow-up of the all-comer registry. Aging Clin Exp Res 29:885–893CrossRefGoogle Scholar
  18. 18.
    Kawecki D, Morawiec B, Dola J, Wanha W, Smolka G, Pluta A, Marcinkiewicz K, Ochala A, Nowalany-Kozielska E, Wojakowski W (2016) First- versus second-generation drug-eluting stents in acute coronary syndromes (Katowice-Zabrze registry). Arq Bras Cardiol 106:373–381Google Scholar
  19. 19.
    Kawecki D, Morawiec B, Dola J, Wanha W, Smolka G, Pluta A, Marcinkiewicz K, Ochala A, Nowalany-Kozielska E, Wojakowski W (2015) Comparison of first- and second-generation drug-eluting stents in an all-comer population of patients with diabetes mellitus (from Katowice-Zabrze registry). Med Sci Monit 21:3261–3269CrossRefGoogle Scholar
  20. 20.
    Galloe AM, Kelbaek H, Thuesen L, Hansen HS, Ravkilde J, Hansen PR, Christiansen EH, Abildgaard U, Stephansen G, Lassen JF, Engstrom T, Jensen JS, Jeppesen JL, Bligaard N, Investigators SOI (2017) 10-Year clinical outcome after randomization to treatment by sirolimus- or paclitaxel-eluting coronary stents. J Am Coll Cardiol 69:616–624CrossRefGoogle Scholar
  21. 21.
    Jensen LO, Thayssen P, Christiansen EH, Maeng M, Ravkilde J, Hansen KN, Hansen HS, Krusell L, Kaltoft A, Tilsted HH, Berencsi K, Junker A, Lassen JF, Investigators SOI (2016) Safety and efficacy of everolimus- versus sirolimus-eluting stents: 5-year results from SORT OUT IV. J Am Coll Cardiol 67:751–762CrossRefGoogle Scholar
  22. 22.
    Kobayashi N, Ito Y, Yamawaki M, Araki M, Sakai T, Obokata M, Sakamoto Y, Mori S, Tsutsumi M, Nauchi M, Honda Y, Tokuda T, Makino K, Shirai S, Hirano K (2018) Differences between first-generation and second-generation drug-eluting stent regarding in-stent neoatherosclerosis characteristics: an optical coherence tomography analysis. Int J Cardiovasc Imaging. Google Scholar
  23. 23.
    Stone GW, McLaurin BT, Cox DA, Bertrand ME, Lincoff AM, Moses JW, White HD, Pocock SJ, Ware JH, Feit F, Colombo A, Aylward PE, Cequier AR, Darius H, Desmet W, Ebrahimi R, Hamon M, Rasmussen LH, Rupprecht HJ, Hoekstra J, Mehran R, Ohman EM, Investigators A (2006) Bivalirudin for patients with acute coronary syndromes. N Engl J Med 355:2203–2216CrossRefGoogle Scholar
  24. 24.
    Wiviott SD, Braunwald E, McCabe CH, Montalescot G, Ruzyllo W, Gottlieb S, Neumann FJ, Ardissino D, De Servi S, Murphy SA, Riesmeyer J, Weerakkody G, Gibson CM, Antman EM, Investigators T-T (2007) Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 357:2001–2015CrossRefGoogle Scholar
  25. 25.
    Wallentin L, Becker RC, Budaj A, Cannon CP, Emanuelsson H, Held C, Horrow J, Husted S, James S, Katus H, Mahaffey KW, Scirica BM, Skene A, Steg PG, Storey RF, Harrington RA, Freij A, Thorsen M, Investigators P (2009) Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 361:1045–1057CrossRefGoogle Scholar

Copyright information

© Springer Japan KK, part of Springer Nature 2018

Authors and Affiliations

  • Ming-Jer Hsieh
    • 1
  • Chun-Chi Chen
    • 1
  • Cheng-Hung Lee
    • 1
  • Chao-Yung Wang
    • 1
  • Shang-Hung Chang
    • 1
  • Dong-Yi Chen
    • 1
  • Chia-Hung Yang
    • 1
  • Ming-Lung Tsai
    • 1
  • Jih-Kai Yeh
    • 1
  • Ming-Yun Ho
    • 1
  • I-Chang Hsieh
    • 1
    Email author
  1. 1.Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial HospitalChang Gung University College of MedicineTaoyuanTaiwan

Personalised recommendations