Timing of Complete Multivessel Revascularization in Patients Presenting With Non-ST-Segment Elevation Acute Coronary Syndrome: 2-Year Results of the BIOVASC Study

Wijnand K. den Dekker; Jacob J. Elscot; Johan Bennett; Carl E. Schotborgh; René J. van der Schaaf; Manel Sabaté; Raúl Moreno; Koen Ameloot; Rutger van Bommel; Daniele Forlani; Bert Van Reet; Giovanni Esposito; Maurits T. Dirksen; Willem T. Ruifrok; Bert R. Everaert; Carlos Van Mieghem; Paul Cummins; Mattie Lenzen; Salvatore Brugaletta; Eric Boersma; Nicolas M. Van Mieghem; Roberto Diletti; Roberto Diletti; Wijnand K. den Dekker; Nicolas M. Van Mieghem; Carl E. Schotborgh; René J. van der Schaaf; Rutger van Bommel; Maurits T. Dirksen; Willem T. Ruifrok; Gillian A.J. Jessurun; Michael Magro; Michiel Voskuil; George J. Vlachojannis; Marcel A.M. Beijk; Abdelilah el Barzouhi; Dirk J. van der Heijden; Johan Bennett; Koen Ameloot; Mathias Vrolix; Bert Van Reet; Bert R. Everaert; Bert Vandeloo; Carlos Van Mieghem; Francis Stammen; Stefan Verheye; Daniele Forlani; Massimo Di Marco; Leonardo Paloscia; Giovanni Esposito; Anna Franzone; Sergio Berti; Alberto R. De Caterina; Marco Ciardetti; Gioel G. Secco; Manel Sabaté; Salvatore Brugaletta; Raúl Moreno; Eduardo Pinar; Fernando Alfonso; Ignacio J. Amat; Cesar Moris; Wijnand K. den Dekker; Nicolas M. Van Mieghem; Johan Bennett; Giovanni Esposito; Manel Sabaté; Joost Daemen; Hector M. Garcia-Garcia; Eugène McFadden; Grethe Andersen; Jan G.P. Tijssen; Jurriën M. ten Berg; Freek W.A. Verheugt

doi:10.1016/j.jcin.2024.01.278

Timing of Complete Multivessel Revascularization in Patients Presenting With Non-ST-Segment Elevation Acute Coronary Syndrome: 2-Year Results of the BIOVASC Study

Wijnand K. den Dekker^*
, Jacob J. Elscot
, Johan Bennett
, Carl E. Schotborgh
, René J. van der Schaaf
, Manel Sabaté
, Raúl Moreno
, Koen Ameloot
, Rutger van Bommel
, Daniele Forlani
, Bert Van Reet
, Giovanni Esposito
, Maurits T. Dirksen
, Willem T. Ruifrok
, Bert R. Everaert
, Carlos Van Mieghem
, Paul Cummins
, Mattie Lenzen
, Salvatore Brugaletta
, Eric Boersma

Nicolas M. Van Mieghem, Roberto Diletti, Roberto Diletti, Wijnand K. den Dekker, Nicolas M. Van Mieghem, Carl E. Schotborgh, René J. van der Schaaf, Rutger van Bommel, Maurits T. Dirksen, Willem T. Ruifrok, Gillian A.J. Jessurun, Michael Magro, Michiel Voskuil, George J. Vlachojannis, Marcel A.M. Beijk, Abdelilah el Barzouhi, Dirk J. van der Heijden, Johan Bennett, Koen Ameloot, Mathias Vrolix, Bert Van Reet, Bert R. Everaert, Bert Vandeloo, Carlos Van Mieghem, Francis Stammen, Stefan Verheye, Daniele Forlani, Massimo Di Marco, Leonardo Paloscia, Giovanni Esposito, Anna Franzone, Sergio Berti, Alberto R. De Caterina, Marco Ciardetti, Gioel G. Secco, Manel Sabaté, Salvatore Brugaletta, Raúl Moreno, Eduardo Pinar, Fernando Alfonso, Ignacio J. Amat, Cesar Moris, Wijnand K. den Dekker, Nicolas M. Van Mieghem, Johan Bennett, Giovanni Esposito, Manel Sabaté, Joost Daemen, Hector M. Garcia-Garcia, Eugène McFadden, Grethe Andersen, Jan G.P. Tijssen, Jurriën M. ten Berg, Freek W.A. Verheugt

^*Corresponding author for this work

Cardiology

Research output: Contribution to journal › Article › Academic › peer-review

16 Citations (Scopus)

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Abstract

Background:

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.

Objectives:

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

Methods:

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.

Results:

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).

Conclusions:

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

Original language	English
Pages (from-to)	771-782
Number of pages	12
Journal	JACC: Cardiovascular Interventions
Volume	17
Issue number	6
DOIs	https://doi.org/10.1016/j.jcin.2024.01.278
Publication status	Published - 25 Mar 2024

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Publisher Copyright:
© 2024 The Authors

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den Dekker, W. K., Elscot, J. J., Bennett, J., Schotborgh, C. E., van der Schaaf, R. J., Sabaté, M., Moreno, R., Ameloot, K., van Bommel, R., Forlani, D., Van Reet, B., Esposito, G., Dirksen, M. T., Ruifrok, W. T., Everaert, B. R., Van Mieghem, C., Cummins, P., Lenzen, M., Brugaletta, S., ... Verheugt, F. W. A. (2024). Timing of Complete Multivessel Revascularization in Patients Presenting With Non-ST-Segment Elevation Acute Coronary Syndrome: 2-Year Results of the BIOVASC Study. JACC: Cardiovascular Interventions, 17(6), 771-782. https://doi.org/10.1016/j.jcin.2024.01.278

@article{e2ede3e5938445759436ddc9176f8eac,

title = "Timing of Complete Multivessel Revascularization in Patients Presenting With Non-ST-Segment Elevation Acute Coronary Syndrome: 2-Year Results of the BIOVASC Study",

abstract = "Background: 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. Objectives: This study aims to compare immediate complete revascularization (ICR) and staged complete revascularization (SCR) in patients presenting with NSTE-ACS and MVD. Methods: 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. Results: 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).Conclusions: ICR is safe in patients with NSTE-ACS and MVD and was associated with a reduction in MIs and UIDRs at 1 year.",

author = "\{den Dekker\}, \{Wijnand K.\} and Elscot, \{Jacob J.\} and Johan Bennett and Schotborgh, \{Carl E.\} and \{van der Schaaf\}, \{Ren{\'e} J.\} and Manel Sabat{\'e} and Ra{\'u}l Moreno and Koen Ameloot and \{van Bommel\}, Rutger and Daniele Forlani and \{Van Reet\}, Bert and Giovanni Esposito and Dirksen, \{Maurits T.\} and Ruifrok, \{Willem T.\} and Everaert, \{Bert R.\} and \{Van Mieghem\}, Carlos and Paul Cummins and Mattie Lenzen and Salvatore Brugaletta and Eric Boersma and \{Van Mieghem\}, \{Nicolas M.\} and Roberto Diletti and Roberto Diletti and \{den Dekker\}, \{Wijnand K.\} and \{Van Mieghem\}, \{Nicolas M.\} and Schotborgh, \{Carl E.\} and \{van der Schaaf\}, \{Ren{\'e} J.\} and \{van Bommel\}, Rutger and Dirksen, \{Maurits T.\} and Ruifrok, \{Willem T.\} and Jessurun, \{Gillian A.J.\} and Michael Magro and Michiel Voskuil and Vlachojannis, \{George J.\} and Beijk, \{Marcel A.M.\} and Barzouhi, \{Abdelilah el\} and \{van der Heijden\}, \{Dirk J.\} and Johan Bennett and Koen Ameloot and Mathias Vrolix and \{Van Reet\}, Bert and Everaert, \{Bert R.\} and Bert Vandeloo and \{Van Mieghem\}, Carlos and Francis Stammen and Stefan Verheye and Daniele Forlani and \{Di Marco\}, Massimo and Leonardo Paloscia and Giovanni Esposito and Anna Franzone and Sergio Berti and \{De Caterina\}, \{Alberto R.\} and Marco Ciardetti and Secco, \{Gioel G.\} and Manel Sabat{\'e} and Salvatore Brugaletta and Ra{\'u}l Moreno and Eduardo Pinar and Fernando Alfonso and Amat, \{Ignacio J.\} and Cesar Moris and \{den Dekker\}, \{Wijnand K.\} and \{Van Mieghem\}, \{Nicolas M.\} and Johan Bennett and Giovanni Esposito and Manel Sabat{\'e} and Joost Daemen and Garcia-Garcia, \{Hector M.\} and Eug{\`e}ne McFadden and Grethe Andersen and Tijssen, \{Jan G.P.\} and \{ten Berg\}, \{Jurri{\"e}n M.\} and Verheugt, \{Freek W.A.\}",

note = "Publisher Copyright: {\textcopyright} 2024 The Authors",

year = "2024",

month = mar,

day = "25",

doi = "10.1016/j.jcin.2024.01.278",

language = "English",

volume = "17",

pages = "771--782",

journal = "JACC: Cardiovascular Interventions",

issn = "1936-8798",

publisher = "Elsevier Inc.",

number = "6",

}

den Dekker, WK , Elscot, JJ, Bennett, J, Schotborgh, CE, van der Schaaf, RJ, Sabaté, M, Moreno, R, Ameloot, K, van Bommel, R, Forlani, D, Van Reet, B, Esposito, G, Dirksen, MT, Ruifrok, WT, Everaert, BR, Van Mieghem, C, Cummins, P, Lenzen, M, Brugaletta, S, Boersma, E , Van Mieghem, NM , Diletti, R , Diletti, R , den Dekker, WK , Van Mieghem, NM, Schotborgh, CE, van der Schaaf, RJ, van Bommel, R, Dirksen, MT, Ruifrok, WT, Jessurun, GAJ, Magro, M, Voskuil, M, Vlachojannis, GJ, Beijk, MAM, Barzouhi, AE, van der Heijden, DJ, Bennett, J, Ameloot, K, Vrolix, M, Van Reet, B, Everaert, BR, Vandeloo, B, Van Mieghem, C, Stammen, F, Verheye, S, Forlani, D, Di Marco, M, Paloscia, L, Esposito, G, Franzone, A, Berti, S, De Caterina, AR, Ciardetti, M, Secco, GG, Sabaté, M, Brugaletta, S, Moreno, R, Pinar, E, Alfonso, F, Amat, IJ, Moris, C, den Dekker, WK , Van Mieghem, NM, Bennett, J, Esposito, G, Sabaté, M, Daemen, J, Garcia-Garcia, HM, McFadden, E, Andersen, G, Tijssen, JGP, ten Berg, JM & Verheugt, FWA 2024, 'Timing of Complete Multivessel Revascularization in Patients Presenting With Non-ST-Segment Elevation Acute Coronary Syndrome: 2-Year Results of the BIOVASC Study', JACC: Cardiovascular Interventions, vol. 17, no. 6, pp. 771-782. https://doi.org/10.1016/j.jcin.2024.01.278

Timing of Complete Multivessel Revascularization in Patients Presenting With Non-ST-Segment Elevation Acute Coronary Syndrome: 2-Year Results of the BIOVASC Study. / den Dekker, Wijnand K.; Elscot, Jacob J.; Bennett, Johan et al.
In: JACC: Cardiovascular Interventions, Vol. 17, No. 6, 25.03.2024, p. 771-782.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Timing of Complete Multivessel Revascularization in Patients Presenting With Non-ST-Segment Elevation Acute Coronary Syndrome

T2 - 2-Year Results of the BIOVASC Study

AU - den Dekker, Wijnand K.

AU - Elscot, Jacob J.

AU - Bennett, Johan

AU - Schotborgh, Carl E.

AU - van der Schaaf, René J.

AU - Sabaté, Manel

AU - Moreno, Raúl

AU - Ameloot, Koen

AU - van Bommel, Rutger

AU - Forlani, Daniele

AU - Van Reet, Bert

AU - Esposito, Giovanni

AU - Dirksen, Maurits T.

AU - Ruifrok, Willem T.

AU - Everaert, Bert R.

AU - Van Mieghem, Carlos

AU - Cummins, Paul

AU - Lenzen, Mattie

AU - Brugaletta, Salvatore

AU - Boersma, Eric

AU - Van Mieghem, Nicolas M.

AU - Diletti, Roberto

AU - den Dekker, Wijnand K.

AU - Van Mieghem, Nicolas M.

AU - Schotborgh, Carl E.

AU - van der Schaaf, René J.

AU - van Bommel, Rutger

AU - Dirksen, Maurits T.

AU - Ruifrok, Willem T.

AU - Jessurun, Gillian A.J.

AU - Magro, Michael

AU - Voskuil, Michiel

AU - Vlachojannis, George J.

AU - Beijk, Marcel A.M.

AU - Barzouhi, Abdelilah el

AU - van der Heijden, Dirk J.

AU - Bennett, Johan

AU - Ameloot, Koen

AU - Vrolix, Mathias

AU - Van Reet, Bert

AU - Everaert, Bert R.

AU - Vandeloo, Bert

AU - Van Mieghem, Carlos

AU - Stammen, Francis

AU - Verheye, Stefan

AU - Forlani, Daniele

AU - Di Marco, Massimo

AU - Paloscia, Leonardo

AU - Esposito, Giovanni

AU - Franzone, Anna

AU - Berti, Sergio

AU - De Caterina, Alberto R.

AU - Ciardetti, Marco

AU - Secco, Gioel G.

AU - Sabaté, Manel

AU - Brugaletta, Salvatore

AU - Moreno, Raúl

AU - Pinar, Eduardo

AU - Alfonso, Fernando

AU - Amat, Ignacio J.

AU - Moris, Cesar

AU - den Dekker, Wijnand K.

AU - Van Mieghem, Nicolas M.

AU - Bennett, Johan

AU - Esposito, Giovanni

AU - Sabaté, Manel

AU - Daemen, Joost

AU - Garcia-Garcia, Hector M.

AU - McFadden, Eugène

AU - Andersen, Grethe

AU - Tijssen, Jan G.P.

AU - ten Berg, Jurriën M.

AU - Verheugt, Freek W.A.

PY - 2024/3/25

Y1 - 2024/3/25

N2 - Background: 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. Objectives: This study aims to compare immediate complete revascularization (ICR) and staged complete revascularization (SCR) in patients presenting with NSTE-ACS and MVD. Methods: 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. Results: 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).Conclusions: ICR is safe in patients with NSTE-ACS and MVD and was associated with a reduction in MIs and UIDRs at 1 year.

AB - Background: 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. Objectives: This study aims to compare immediate complete revascularization (ICR) and staged complete revascularization (SCR) in patients presenting with NSTE-ACS and MVD. Methods: 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. Results: 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).Conclusions: ICR is safe in patients with NSTE-ACS and MVD and was associated with a reduction in MIs and UIDRs at 1 year.

UR - https://www.scopus.com/pages/publications/85187723289

U2 - 10.1016/j.jcin.2024.01.278

DO - 10.1016/j.jcin.2024.01.278

M3 - Article

C2 - 38538172

AN - SCOPUS:85187723289

SN - 1936-8798

VL - 17

SP - 771

EP - 782

JO - JACC: Cardiovascular Interventions

JF - JACC: Cardiovascular Interventions

IS - 6

ER -

Timing of Complete Multivessel Revascularization in Patients Presenting With Non-ST-Segment Elevation Acute Coronary Syndrome: 2-Year Results of the BIOVASC Study

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