Abstract
This thesis explores advanced revascularization strategies for patients with
multivessel coronary artery disease, aiming to optimize both short- and long
term clinical outcomes. The work is structured in three main parts, each
addressing a crucial aspect of contemporary coronary revascularization.
Part I focuses on the comparison between PCI and CABG. Chapter 3 presents a
systematic review and meta-analysis comparing PCI and CABG in patients with
non-ST-elevation acute coronary syndromes (NSTE-ACS) and MVD. Chapter 4
introduces the design of the PRESENT trial, which evaluates whether patients
with MVD treated with complete revascularization with optical coherence
tomography (OCT)-guidance PCI on outcomes in patients with stable angina
or NSTE-ACS and MVD, excluding chronic total occlusion, compared to CABG.
Part II evaluates the timing of complete revascularization—immediate versus
staged—in patients presenting with ACS. Chapter 5 to Chapter 11 analyze clinical
outcomes across different ACS subtypes, such as STEMI and NSTEMI, and
consider additional factors including sex differences (Chapter 10) and time of
presentation (Chapter 11) by using data from the BIOVASC trial. These chapters
provide comprehensive real-world and trial-based data that contribute to
understanding whether revascularizing all lesions during the index procedure
yields better outcomes than a staged approach.
Part III provides detailed subgroup analyses and explores anatomical and
procedural variables that may influence outcomes. Chapter 12 investigates
how the number of diseased vessels affects the choice between immediate
and staged revascularization. Chapter 13 assesses the prognostic value of the
residual SYNTAX score following complete revascularization. Chapters 14 and
15 delve into the impact of lesion length and coronary calcification, respectively,
on patient outcomes.
Chapter 16, the concluding chapter, integrates findings from all prior studies
and underscores the importance of personalized, anatomy-guided, and timely
revascularization in improving outcomes for patients with complex coronary
artery disease.
multivessel coronary artery disease, aiming to optimize both short- and long
term clinical outcomes. The work is structured in three main parts, each
addressing a crucial aspect of contemporary coronary revascularization.
Part I focuses on the comparison between PCI and CABG. Chapter 3 presents a
systematic review and meta-analysis comparing PCI and CABG in patients with
non-ST-elevation acute coronary syndromes (NSTE-ACS) and MVD. Chapter 4
introduces the design of the PRESENT trial, which evaluates whether patients
with MVD treated with complete revascularization with optical coherence
tomography (OCT)-guidance PCI on outcomes in patients with stable angina
or NSTE-ACS and MVD, excluding chronic total occlusion, compared to CABG.
Part II evaluates the timing of complete revascularization—immediate versus
staged—in patients presenting with ACS. Chapter 5 to Chapter 11 analyze clinical
outcomes across different ACS subtypes, such as STEMI and NSTEMI, and
consider additional factors including sex differences (Chapter 10) and time of
presentation (Chapter 11) by using data from the BIOVASC trial. These chapters
provide comprehensive real-world and trial-based data that contribute to
understanding whether revascularizing all lesions during the index procedure
yields better outcomes than a staged approach.
Part III provides detailed subgroup analyses and explores anatomical and
procedural variables that may influence outcomes. Chapter 12 investigates
how the number of diseased vessels affects the choice between immediate
and staged revascularization. Chapter 13 assesses the prognostic value of the
residual SYNTAX score following complete revascularization. Chapters 14 and
15 delve into the impact of lesion length and coronary calcification, respectively,
on patient outcomes.
Chapter 16, the concluding chapter, integrates findings from all prior studies
and underscores the importance of personalized, anatomy-guided, and timely
revascularization in improving outcomes for patients with complex coronary
artery disease.
| Original language | English |
|---|---|
| Awarding Institution |
|
| Supervisors/Advisors |
|
| Award date | 2 Sept 2025 |
| Place of Publication | Rotterdam |
| Publisher | |
| Print ISBNs | 978-94-6522-447-3 |
| Publication status | Published - 2 Sept 2025 |
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