Percutaneous vs. Surgical Revascularization of Non-ST-Segment Elevation Myocardial Infarction With Multivessel Disease: The SWEDEHEART Registry

The debate continues over long-term outcomes of percutaneous coronary intervention (PCI) vs. coronary artery bypass grafting (CABG) in patients with non-ST-segment elevation myocardial infarction (NSTEMI) and multivessel disease. This study, based on the SWEDEHEART registry, analyzed 57,097 revascularized patients with NSTEMI and multivessel disease in Sweden from January 2005 to June 2022. The primary endpoint was all-cause mortality, encompassing both in-hospital and long-term mortality.  Percutaneous coronary intervention was the primary therapy in 42,190 patients (73.9 percent), while 14,907 (26.1 percent) received CABG. During a median follow-up of 7.1 years, PCI was associated with higher risks of death (adjusted odds ratio [aOR] 1.67; 95 percent confidence interval [CI] 1.54-1.81) and MI (aOR 1.51; 95 percent CI 1.41-1.62), but there was no significant difference in stroke. Repeat revascularization was three times more likely to PCI (aOR 3.01; 95 percent CI 2.57-3.51), while heart failure risk was 15 percent higher (aOR 1.15; 95% CI 1.07-1.25). CABG provided longer survival within 15 years, especially in patients under 70 years of age, with left main disease or left ventricular dysfunction, though, this benefit diminished over shorter time horizons.  The authors concluded that CABG is associated with lower risks of mortality, MI, repeat revascularization, and heart failure in patients with NSTEMI, particularly in high-risk subgroups. However, its survival benefit lessens with shorter life expectancy.