RCT | Immediate complete revascularization non-inferior to staged approach in ACS patients with multivessel disease

Summary: Patients with an acute coronary syndrome and multivessel disease not presenting with cardiogenic shock usually benefit from complete revascularization by percutaneous coronary intervention (PCI). Complete revascularization involves treating all significant blockages in the coronary arteries, including those not causing symptoms (non-culprit lesions).

The BIOVASC randomized non-inferiority trial investigated whether patients with acute coronary syndrome and multivessel coronary disease should undergo immediate complete revascularization during the index procedure or undergo a staged approach with PCI of the culprit lesion only during the index procedure followed by another procedure within 6 weeks of all non-culprit lesions deemed to be clinically significant. The exclusion criteria were:

• Previous coronary artery bypass surgery.
• Cardiogenic shock.
• Single-vessel coronary disease.
• The presence of a chronic coronary total occlusion.

A total of 1525 patients with acute coronary syndrome and multivessel coronary disease were randomly assigned to either an immediate complete revascularization group (764 patients) or a staged complete revascularization group (761 patients). The primary outcome was a composite of all-cause mortality, myocardial infarction, unplanned ischemia-driven revascularization, or cerebrovascular events at 1 year after the index procedure. The study found that immediate complete revascularization was non-inferior to staged complete revascularization for the primary outcome.

Article: Immediate versus staged complete revascularisation in patients presenting with acute coronary syndrome and multivessel coronary disease (BIOVASC): a prospective, open-label, non-inferiority, randomised trial – The Lancet (free registration required)

News Release: Immediate Complete Revascularization as Safe and Effective as Staged Procedure in Treating Multi-Vessel Disease – American College of Cardiology

Commentaries:

Revascularisation in acute coronary syndromes: change in practice? – The Lancet (free registration required)

No Downside to Immediate Complete Revascularization in ACS: BIOVASC – TCTMD

Percutaneous Complete Revascularization Strategies Using Sirolimus-Eluting Biodegradable Polymer-Coated Stents in Patients Presenting With Acute Coronary Syndrome and Multivessel Disease – BIOVASC – American College of Cardiology

Immediate Complete Revascularization Non-Inferior to Staged Procedure in BIOVASC Trial – HCP Live

Related:

The optimal timing for non-culprit percutaneous coronary intervention in patients with multivessel coronary artery disease: A pairwise and network meta-analysis of randomized trials – Frontiers in Cardiovascular Medicine

Multivessel Versus Culprit-Only Revascularization in STEMI and Multivessel Coronary Artery Disease: Meta-Analysis of Randomized Trials – Journal of the American College of Cardiology

Complete Revascularization During Primary Percutaneous Coronary Intervention Reduces Death and Myocardial Infarction in Patients With Multivessel Disease: Meta-Analysis and Meta-Regression of Randomized Trials – JACC: Cardiovascular Interventions

Complete Revascularization with Multivessel PCI for Myocardial Infarction – New England Journal of Medicine

One-Year Outcomes after PCI Strategies in Cardiogenic Shock – New England Journal of Medicine

PCI Strategies in Patients with Acute Myocardial Infarction and Cardiogenic Shock – New England Journal of Medicine