Non-Culprit Revascularization Timing in (N)STE-ACS: A Patient Preference Report

Objectives: To elucidate the preference of (non)ST-Segment Elevation Acute Coronary Syndrome ((N)STE-ACS) patients with Multivessel Disease (MVD), with regard to the timing of Non-Culprit Lesion (NCL) treatment by Percutaneous Coronary Intervention (PCI). Methods: At the end of 2020, a survey was sent to 442 patients who received PCI for (N) STE-ACS between December 2018 and October 2020 at Radboudumc, Nijmegen, the Netherlands. The primary outcome was patient preference for the timing of NCL revascularization, being during index PCI, during index admission, or as an outpatient procedure. The secondary outcomes consisted of peri-procedural complaints and symptoms of ischemia, namely chest pain and dyspnoea, during exercise and at rest. Secondly, effects on mental well-being were assessed. All symptoms were graded on a 5-point scale to allow for a quantitative comparison. Finally, unplanned visits with cardiac symptoms were scored. Results: Of the 442 invited patients, 265 (60%) responded of whom 197 (45%) were included and 68 (15%) were excluded. Overall, the majority of patients (69%) preferred direct complete revascularization. Non-invasive imaging-guided PCI was chosen by 23% of patients. Interestingly, MVD patients (n=98) who underwent a single PCI procedure consulted the physician with cardiac complaints less frequently than patients who underwent multiple procedures (21.4% vs. 53.6%, p=0.001) and had lower chest pain scores (1.36±0.62 vs. 1.95±1.07, p=0.001). Conclusion: Complete revascularization of all non-culprit lesions during index PCI was the preferred treatment and was associated with reduced chest pain severity and fewer consultations for cardiac symptoms.