title: Culprit only versus complete coronary revascularization during primary PCI.
abstract: BACKGROUND
  Primary percutaneous intervention (PCI) is the treatment of choice for acute ST elevation myocardial infarction. Currently it is recommended to treat only the culprit artery during the acute procedure. Only few reports describe the results of simultaneous non-culprit vessel PCI. The study hypothesizes that complete revascularization during primary PCI can be achieved safely with an improved clinical outcome during the indexed hospitalization.
  
  
  METHODS
  One hundred and twenty consecutive patients presented with acute ST elevation myocardial infarction (STEMI) and multivessel coronary stenosis. Ninety five underwent complete revascularization (CR): the culprit artery was opened first followed by dilatation of the other significantly narrowed arteries. Twenty five had culprit only revascularization (COR): the culprit artery only was dilated and the other arteries were left untreated during the primary PCI.
  
  
  RESULTS
  Complete revascularization (CR) was associated with reduced incidence of major cardiac events (recurrent ischemia, reinfarction, acute heart failure and in-hospital mortality 16.7 versus 52%, P=0.0001). There was a significant lower rate of recurrent ischemic episodes (4.2% versus 32%, P=0.002), myocardial reinfarction (3.1% versus 16%, P=0.01), reintervention (7.3% versus 32%, P=0.001), acute heart failure (9.4% versus 32%, P=0.01) during the indexed hospitalization and shorter hospitalization (4.4+/-1.27 versus 9.6+/-2.3, P=0.001) in the CR group. Transient renal dysfunction was more common in CR patients (8.4% versus 4% P=0.01). In-hospital and one year mortality were similar between the two groups.
  
  
  CONCLUSIONS
  Multivessel PCI during acute myocardial infarction is feasible and safe. Complete revascularization resulted in an improved acute clinical course. These data support a policy of complete revascularization during primary PCI for STEMI.
authors.affiliation: Cardiovascular Department, Poria Medical Center, Israel.
authors.forename: Dahud
authors.initials: D
authors.lastname: Qarawani
authors.forename: Menachem
authors.initials: M
authors.lastname: Nahir
authors.forename: Mouin
authors.initials: M
authors.lastname: Abboud
authors.forename: Yevgeny
authors.initials: Y
authors.lastname: Hazanov
authors.forename: Yonathan
authors.initials: Y
authors.lastname: Hasin
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D015331:Cohort Studies; D016001:Confidence Intervals; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D003331:Coronary Vessels / Q000473:pathology*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016017:Odds Ratio; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome