Complete Revascularization Versus Culprit-Only Percutaneous Coronary Intervention in Non–ST-Elevation Myocardial Infarction With Multivessel Disease: A Nationwide Propensity Score–Matched Analysis

Abstract

We used the National Inpatient Sample from 2016 to 2022 to compare complete revascularization with culprit-only percutaneous coronary intervention in adults hospitalized with non-ST-elevation myocardial infarction and multivessel disease. Hospitalizations complicated by cardiogenic shock, cardiac arrest, coronary artery bypass grafting, or mechanical circulatory support were excluded. Complete revascularization was defined as intervention on at least 2 native coronary territories during the index admission. We performed 1:1 propensity score matching on 52 covariates. The primary outcome was in-hospital major bleeding. Among 713,844 weighted hospitalizations (142,769 unweighted), 27.5% underwent complete revascularization. Matching yielded 37,048 well-balanced pairs (all standardized mean differences <0.01). Complete revascularization was associated with more major bleeding (12.22% vs 10.52%; odds ratio 1.18; 95% confidence interval, 1.13-1.24; P < 0.001), whereas in-hospital mortality was similar (1.01% vs 0.98%; P = 0.684). Major adverse cardiovascular events trended lower (14.61% vs 15.10%; P = 0.062), driven by less recurrent myocardial infarction (P = 0.034). Complete revascularization was also associated with a longer stay (3 vs 2 days) and higher cost ($127,536 vs $91,771; both P < 0.001). The excess bleeding was consistent across 17 subgroups and greatest in patients younger than 65 years (P for interaction < 0.001).