Timing of Complete Multivessel Revascularization in Patients Presenting With Non-ST-Segment Elevation Acute Coronary Syndrome

Jacob J. Elscot, Hala Kakar, Paola Scarparo, Wijnand K. den Dekker, Johan Bennett, Carl E. Schotborgh, René van der Schaaf, Manel Sabaté, Raúl Moreno, Koen Ameloot, Rutger J. van Bommel, Daniele Forlani, Bert Van Reet, Giovanni Esposito, Maurits T. Dirksen, Willem P.T. Ruifrok, Bert R.C. Everaert, Carlos Van Mieghem, Eduardo Pinar, Fernando AlfonsoPaul Cummins, Mattie Lenzen, Salvatore Brugaletta, Joost Daemen, Eric Boersma, Nicolas M. Van Mieghem, Roberto Diletti*, BIOVASC Investigators

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

3 Citations (Scopus)
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Complete revascularization of the culprit and all significant nonculprit lesions in patients with non–ST-segment elevation acute coronary syndrome (NSTE-ACS) and multivessel disease (MVD) reduces major adverse cardiac events, but optimal timing of revascularization remains unclear. 


This study aims to compare immediate complete revascularization (ICR) and staged complete revascularization (SCR) in patients presenting with NSTE-ACS and MVD. 


This prespecified substudy of the BIOVASC (Percutaneous Complete Revascularization Strategies Using Sirolimus Eluting Biodegradable Polymer Coated Stents in Patients Presenting With Acute Coronary Syndrome and Multivessel Disease) trial included patients with NSTE-ACS and MVD. Risk differences of the primary composite outcome of all-cause mortality, myocardial infarction (MI), unplanned ischemia-driven revascularization (UIDR), or cerebrovascular events and its individual components were compared between ICR and SCR at 1 year. 


The BIOVASC trial enrolled 1,525 patients; 917 patients presented with NSTE-ACS, of whom 459 were allocated to ICR and 458 to SCR. Incidences of the primary composite outcome were similar in the 2 groups (7.9% vs 10.1%; risk difference 2.2%; 95% CI: −1.5 to 6.0; P = 0.15). ICR was associated with a significant reduction of MIs (2.0% vs 5.3%; risk difference 3.3%; 95% CI: 0.9 to 5.7; P = 0.006), which was maintained after exclusion of procedure-related MIs occurring during the index or staged procedure (2.0% vs 4.4%; risk difference 2.4%; 95% CI: 0.1 to 4.7; P = 0.032). UIDRs were also reduced in the ICR group (4.2% vs 7.8%; risk difference 3.5%; 95% CI: 0.4 to 6.6; P = 0.018).


ICR is safe in patients with NSTE-ACS and MVD and was associated with a reduction in MIs and UIDRs at 1 year.

Original languageEnglish
Pages (from-to)771-782
Number of pages12
JournalJACC: Cardiovascular Interventions
Issue number6
Publication statusPublished - 25 Mar 2024

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