Comparing Stenting and Surgery for Multivessel and Left Main Coronary Artery Disease in Patients With Non-ST Elevation Acute Coronary Syndrome

What this Trial Is About

Researchers are investigating the best way to treat patients with multivessel coronary artery disease or left main narrowing who experience symptoms of acute ischemia, specifically those with non-ST-segment elevation acute coronary syndrome NSTE-ACS. This trial compares two treatments percutaneous coronary intervention PCI with drug-eluting stents and coronary artery bypass grafting CABG. The study aims to understand which method offers better outcomes for patients with complex coronary artery disease who need early invasive treatment. The study enrolls patients with multivessel disease or left main coronary artery disease, eligible for invasive treatment and with a Syntax Score below 33. Participants will be randomly assigned to receive either PCI, involving fractional flow reserve or iFR measurements and optimized stent implantation, or CABG surgery, performed with techniques including on-pump or off-pump methods. Treatment decisions involve a Heart Team consultation, and both approaches aim for complete revascularization. The trial will follow patients over time to compare outcomes. Participants will have follow-up visits including cardiac echocardiography and stress tests after hospitalization. The study will monitor major adverse cardiac and cerebral events MACCE, serious adverse events, procedural complications, cost effectiveness, and heart function over one year and beyond. Secondary outcomes include bleeding, atrial fibrillation, heart failure, rehospitalization, and quality of life. The total study duration extends until 2030, with primary outcome assessment at one year.

Revascularization Strategies in Patients With Non-ST-Segment Elevation Acute Coronary Syndrome (NSTE-ACS) and Severe Coronary Artery Disease