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Single-Staged Compared With Multi-Staged PCI in Multivessel NSTEMI Patients
Open accessAbstract
Background A lack of clarity exists about the role of complete coronary revascularization in patients presenting with non-ST-segment elevation myocardial infarction.Objectives The aim of our study was to compare long-term outcomes in terms of major adverse cardiovascular and cerebrovascular events of 2 different complete coronary revascularization strategies in patients with non-ST-segment elevation myocardial infarction and multivessel coronary artery disease: 1-stage percutaneous coronary intervention (1S-PCI) during the index procedure versus multistage percutaneous coronary intervention (MS-PCI) complete coronary revascularization during the index hospitalization.Methods In the SMILE (Impact of Different Treatment in Multivessel Non ST Elevation Myocardial Infarction Patients: One Stage Versus Multistaged Percutaneous Coronary Intervention) trial, 584 patients were randomly assigned in a 1:1 manner to 1S-PCI or MS-PCI. The primary study endpoint was the incidence of major adverse cardiovascular and cerebrovascular events, which were defined as cardiac death, death, reinfarction, rehospitalization for unstable angina, repeat coronary revascularization (target vessel revascularization), and stroke at 1 year.Results The occurrence of the primary endpoint was significantly lower in the 1-stage group (1S-PCI: n = 36 [13.63%] vs. MS-PCI: n = 61 [23.19%]; hazard ratio [HR]: 0.549 [95% confidence interval (CI): 0.363 to 0.828]; p = 0.004). The 1-year rate of target vessel revascularization was significantly higher in the MS-PCI group (1S-PCI: n = 22 [8.33%] vs. MS-PCI: n = 40 [15.20%]; HR: 0.522 [95% CI: 0.310 to 0.878]; p = 0.01; p log-rank = 0.013). When the analyses were limited to cardiac death (1S-PCI: n = 9 [3.41%] vs. MS-PCI: n = 14 [5.32%]; HR: 0.624 [95% CI: 0.270 to 1.441]; p = 0.27) and myocardial infarction (1S-PCI: n = 7 [2.65%] vs. MS-PCI: n = 10 [3.80%]; HR: 0.678 [95% CI: 0.156 to 2.657]; p = 0.46), no significant differences were observed between groups.Conclusions In multivessel non-ST-segment elevation myocardial infarction patients, complete 1-stage coronary revascularization is superior to multistage PCI in terms of major adverse cardiovascular and cerebrovascular events. (Impact of Different Treatment in Multivessel Non ST Elevation Myocardial Infarction [NSTEMI]Patients One Stage Versus Multistaged Percutaneous Coronary Intervention [PCI] [SMILE]: NCT01478984).
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“Diabetes is a frequent comorbidity in patients hospitalized for ACS, with an increasing prevalence over the last decade and a high mortality rate.409”
From 2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes. (2023) · cites this paper as [409]
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MethodResultCompleteness of revascularisation in acute coronary syndrome patients with multivessel disease
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“Lower rates of major adverse cardiovascular and cerebrovascular events in the ad hoc group were documented at a 1-year follow up.(31) However, the difference was essentially driven by the higher rate of target vessel revascularisation in the multistage group.”
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Management des akuten Koronarsyndroms
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Pustjens, T. F. S., Veenstra, L. F., Camaro, C., Ruiters, A. W., Lux, Á., Ruzsa, Z., Piróth, Z., Ilhan, M., Vainer, J., Gho, B. C. G., et al. (2025) · JAMA · doi:10.1001/jama.2025.16189 · Cited by 12
Feistritzer, H., Jobs, A., Zeymer, U., Schneider, S., Lauten, P., Ferenc, M., Weferling, M., Brinkmann, R., Winkler, S., Landmesser, U., et al. (2025) · American Heart Journal · doi:10.1016/j.ahj.2025.04.007 · Cited by 11
Timing and completeness of revascularisation in acute coronary syndromes
Sanz‐Sánchez, J., & Stefanini, G. G. (2021) · Heart · doi:10.1136/heartjnl-2020-316743 · Cited by 11
Wang, C., Lang, J., Zhang, J., Hu, Y., Han, C., Xu, R., Wu, J., Liu, C., Li, W., Li, T., et al. (2022) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2022.1033475 · Cited by 13
Henriques, J. P. S., & Claessen, B. E. P. M. (2016) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2015.10.064 · Cited by 11
Bianchini, E., Basile, M., Bianchini, F., Zito, A., Romagnoli, E., Aurigemma, C., Paraggio, L., Lunardi, M., Laborante, R., Fracassi, F., et al. (2024) · International Journal of Cardiology · doi:10.1016/j.ijcard.2024.132392 · Cited by 10
Chyrchel, M., Hałubiec, P., Łazarczyk, A., Duchnevič, O., Okarski, M. T., Gębska, M., & Surdacki, A. (2020) · Journal of Clinical Medicine · doi:10.3390/jcm9061812 · Cited by 10
Iqbal, M. B., Smith, R. D., Lane, R., Patel, N., Mattar, W., Kabir, T., Panoulas, V. F., Mason, M. J., Dalby, M. C. D., Grocott-Mason, R. M., et al. (2017) · Catheterization and Cardiovascular Interventions · doi:10.1002/ccd.27331 · Cited by 10
Correia, C., Braga, C. G., Martins, J., Arantes, C., Abreu, G., Quina, C., Salgado, A., Pereira, M. Á., Costa, J., & Marques, J. H. S. (2018) · Revista Portuguesa de Cardiologia · doi:10.1016/j.repc.2017.05.010 · Cited by 10
“Artéria ou ramo por revascularizar < 0,001 TC 0% (0) 0% (0) DA 12,7% (9) 26,2% (34) Cx 9,9% (7) 17,6% (23) CD 14,1% (10) 21,5% (28) Mais do que uma artéria 0% (0) 35,1% (46)”
BackgroundPustjens, T. F. S., Streukens, B., Vainer, J., Gho, B. C. G., Ruiters, A. W., Stein, M., Ilhan, M., Veenstra, L. F., Theunissen, R. A. L. J., Bekkers, S. C. A. M., et al. (2019) · Netherlands Heart Journal · doi:10.1007/s12471-019-01332-w · Cited by 10
Otsuka, T., Bär, S., Losdat, S., Kavaliauskaite, R., Ueki, Y., Zanchin, C., Lanz, J., Praz, F., Häner, J. D., Siontis, G. C. M., et al. (2021) · Journal of the American Heart Association · doi:10.1161/jaha.121.023129 · Cited by 7
Vriesendorp, P. A., Wilschut, J., Diletti, R., Daemen, J., Kardys, I., Zijlstra, F., Mieghem, N. M. V., Bennett, J., Esposito, G., Sabaté, M., et al. (2022) · Netherlands Heart Journal · doi:10.1007/s12471-022-01687-7 · Cited by 9
Lu, Y., Lee, C., Chen, C., Chen, D., Ho, M.-Y., Yeh, J., Huang, Y., Chang, C.-Y., Wang, C., Chang, S., et al. (2023) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2023.1037392 · Cited by 9
Revascularization Strategy in Myocardial Infarction with Multivessel Disease
Jobs, A., Desch, S., Freund, A., Feistritzer, H., & Thiele, H. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13071918 · Cited by 9
“The SMILE trial suggested the benefit of single-stage complete revascularization over a multi-stage approach concerning the combined endpoint of major adverse cardiovascular and cerebrovascular events [24].”
BackgroundMethodSingle-session versus staged procedures for elective multivessel percutaneous coronary intervention
Toyota, T., Morimoto, T., Shiomi, H., Yamaji, K., Andò, K., Ono, K., Shizuta, S., Saito, N., Kato, T., Kaji, S., et al. (2017) · Heart · doi:10.1136/heartjnl-2017-312117 · Cited by 9
Single-Session Versus Staged Multivessel Optimal IVUS-Guided PCI in Patients With CCS or NSTE-ACS
Yamamoto, K., Shiomi, H., Morimoto, T., Miyazawa, A., Watanabe, H., Nakamura, S., Suwa, S., Domei, T., Ono, K., Sakamoto, H., et al. (2023) · JACC Asia · doi:10.1016/j.jacasi.2023.03.013 · Cited by 8
Revascularization Strategies for Non-ST-Elevation Myocardial Infarction
George, B., Misumida, N., & Ziada, K. M. (2019) · Current Cardiology Reports · doi:10.1007/s11886-019-1125-9 · Cited by 8
Total versus staged versus functional revascularization in NSTEACS patients with multivessel disease
Elkady, A. O., Abdelghany, M., Diab, R., Ezz, A., & Elagha, A. (2021) · The Egyptian Heart Journal · doi:10.1186/s43044-021-00179-0 · Cited by 8
Xu, T., Feng, B., Zheng, Z., Li, L., Zeng, W., Wang, D., Zhang, L., & Li, H. (2021) · BMC Cardiovascular Disorders · doi:10.1186/s12872-021-02212-1 · Cited by 8
Zhu, X., Zhang, P., Xiong, J., Wang, N., Yang, S., Zhu, R.-L., Zhang, L., Liu, W., & Wu, L. (2022) · Medicine · doi:10.1097/md.0000000000031498 · Cited by 7
Montalto, C., Morici, N., Myat, A., Crimi, G., Luca, G. D., Bossi, I. M., de Belder, A., Savonitto, S., & Servi, S. D. (2022) · European Journal of Internal Medicine · doi:10.1016/j.ejim.2022.09.006 · Cited by 7
Kakar, H., Elscot, J. J., Gier, A. D., Scarparo, P., Kardys, I., Nuis, R. J., Wilschut, J., den Dekker, W. K., Daemen, J., Mieghem, N. M. V., et al. (2023) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2023.05.066 · Cited by 7
Suzuki, M., Nishihira, K., Takegami, M., Honda, S., Kojima, S., Takayama, M., Sumiyoshi, T., Ogawa, H., Kimura, K., Yasuda, S., et al. (2020) · Heart and Vessels · doi:10.1007/s00380-020-01654-5 · Cited by 7
Complete Revascularization in Acute and Chronic Coronary Syndrome
Ilardi, F., Ferrone, M. L., Avvedimento, M., Servillo, G., & Gargiulo, G. (2020) · Cardiology Clinics · doi:10.1016/j.ccl.2020.06.003 · Cited by 7
Kovacevic, M., Jones, D. A., Thiele, H., Steg, P. G., & Kunadian, V. (2025) · EuroIntervention · doi:10.4244/eij-d-25-00100 · Cited by 8
Cheema, H. A., Bhanushali, K. B., Sohail, A., Fatima, A., Hermis, A. H., Titus, A., Ahmad, A., Majmundar, V., Rehman, W. U., Sulaiman, S., et al. (2024) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2024.03.037 · Cited by 6
Yasmin, F., Zaidi, S. F., Moeed, A., Shahzad, M., Asghar, M. S., Sadiq, M., Iqbal, J., Surani, S., & Alraies, M. C. (2025) · Clinical Cardiology · doi:10.1002/clc.70105 · Cited by 6
Doğan, C., Bayram, Z., Çap, M., Özkalaycı, F., Unkun, T., Erdoğan, E., Uslu, A., Acar, R. D., Şengör, B. G., Akbal, Ö. Y., et al. (2019) · Medicina · doi:10.3390/medicina55020051 · Cited by 6
Interventional treatment of acute myocardial infarction-related cardiogenic shock
Josiassen, J., Møller, J. E., Holmvang, L., & Hassager, C. (2021) · Current Opinion in Critical Care · doi:10.1097/mcc.0000000000000835 · Cited by 6
Alıcı, G., Quisi, A., Genç, Ö., Harbalıoğlu, H., Allahverdiyev, S., Yıldırım, A., Urgun, Ö. D., & Gür, M. (2021) · Düzce Tıp Fakültesi Dergisi · doi:10.18678/dtfd.868952 · Cited by 6
The year in cardiology 2016: Acute coronary syndromes
Crea, F., Binder, R. K., & Lüscher, T. F. (2017) · Srce i krvni sudovi · doi:10.5937/siks1701011c · Cited by 6
Clinical Value of Single-Projection Angiography–Derived FFR in Noninfarct-Related Artery
Kwon, W., Choi, K. H., Lee, S. H., Hong, D., Shin, D., Kim, H. K., Park, K. H., Choo, E. H., Kim, C. J., Kim, M. C., et al. (2024) · Circulation Cardiovascular Interventions · doi:10.1161/circinterventions.123.013844 · Cited by 5
Singh, S. T., Garg, A., Chaudhary, R., Rout, A., Tantry, U. S., Bliden, K. P., & Gurbel, P. A. (2023) · Cardiovascular revascularization medicine · doi:10.1016/j.carrev.2023.10.005 · Cited by 5
Complete Revascularisation Following Acute MI: A Contemporary Review
Gonnah, A. R., Darke, N., Mullen, L., Hung, J., Sandhu, K., & Giblett, J. P. (2025) · Interventional Cardiology Reviews Research Resources · doi:10.15420/icr.2024.39 · Cited by 6
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Rawat, A., Nazly, S., Kumar, J., Khan, T. J., Kaur, K., Kaur, G., Batool, S., & Khan, A. A. (2023) · Cureus · doi:10.7759/cureus.43968 · Cited by 4
“Sources: References [11-24] Cardiovascular Mortality Eight studies were included in the pooled analysis of the risk of cardiovascular mortality between patients in immediate and stage complete revascularization.”
MethodWang, G., Xiu-Huan, C. H. E. N., Li, S., ZHANG, Z.-K., Gong, W., Yan, Y., Nie, S., & Henriques, J. P. S. (2023) · 老年心脏病学杂志:英文版 · doi:10.26599/1671-5411.2023.10.003 · Cited by 4
The year in cardiology 2016: acute coronary syndromes
Crea, F., Binder, R. K., & Lüscher, T. F. (2016) · European Heart Journal · doi:10.1093/eurheartj/ehw620 · Cited by 4
Coronary revascularization and use of hemodynamic support in acute coronary syndromes
Xenogiannis, I., Tajti, P., Burke, M. N., Chavez, I. J., Gössl, M., Mooney, M. R., Poulose, A. K., Sorajja, P., Traverse, J. H., Wang, Y. L., et al. (2019) · Hellenic Journal of Cardiology · doi:10.1016/j.hjc.2019.01.010 · Cited by 4
Kim, Y. H., Her, A., Jeong, M. H., Kim, B., Hong, S., Lee, S., Ahn, C., Kim, J., Ko, Y., Choi, D., et al. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10204629 · Cited by 4
Metadata
- Authors
- Sardella, G., Lucisano, L., Garbo, R., Pennacchi, M., Cavallo, E., Stio, R. E., Calcagno, S., Ugo, F., Boccuzzi, G., Fedele, F., & Mancone, M.
- Affiliations
- Sapienza University of Rome (IT)
- Ospedale San Giovanni Bosco (IT)
- Corresponding author
- Sardella, Gennaro
- ORCID
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2016-01
- Volume
- 67
- Issue
- 3
- Pages
- 264-272
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W2266436320
- Cited by
- 168
- References
- 28
- Citations by year
- 2026: 9 · 2025: 17 · 2024: 25 · 2023: 25 · 2022: 17 · 2021: 18 · 2020: 15 · 2019: 14 · 2018: 11 · 2017: 9 · 2016: 7
- FWCI
- 15.13
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Coronary Interventions and Diagnostics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
- Keywords
- complete coronary revascularization, major adverse cardiac and cerebrovascular events, target vessel revascularization, cardiovascular mortality, long-term outcomes, multivessel coronary artery disease, reinfarction, stroke, hospital readmission
- MeSH terms
- Coronary Vessels, Humans, Myocardial Infarction, Percutaneous Coronary Intervention
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