title: Management of multivessel coronary disease after ST elevation myocardial infarction treated by primary angioplasty.
abstract: BACKGROUND
  Optimal treatment strategy of patients with ST elevation myocardial infarction (STEMI) and multivessel coronary artery disease (CAD) undergoing primary angioplasty is still unclear. Percutaneous coronary intervention (PCI) of non-culprit vessels simultaneously or soon after primary angioplasty is feasible and safe, but available data failed to consistently show a benefit in long-term clinical outcomes.
  
  
  METHODS
  We retrospectively compared in-hospital and long-term outcomes for patients with STEMI and multivessel CAD treated by primary angioplasty with (Group 1, n=64) or without (Group 2, n=46) early, staged PCI of other angiographically significant coronary lesions. In-hospital major adverse cardiovascular events (MACE) were defined as a composite of death, periprocedural myocardial infarction after staged, elective PCI, stroke, stent thrombosis, major bleeding, and vascular complications. MACE at follow-up were defined as a composite of death, stroke, stent thrombosis, any coronary revascularization, and re-hospitalization for acute coronary syndrome.
  
  
  RESULTS
  Group 1 patients underwent staged PCI 5.9 +/- 3.5 days after primary angioplasty. The mean length of follow-up was 13 months (392 +/- 236 days). The incidence of in-hospital MACE was 20.3% in Group 1 and 10.8% in Group 2 (P=0.186); the incidence of out of hospital MACE was 9.3% in Group 1 and 23.9% in Group 2 (P=0.037). In Group 1 in-hospital MACE were driven by periprocedural myocardial infarction after the elective procedure, which occurred in 15.6% of patients.
  
  
  CONCLUSIONS
  Our data show that multivessel, staged PCI in STEMI patients is associated with a low incidence of adverse events at follow-up but with a higher incidence of in-hospital MACE, mainly driven by periprocedural myocardial infarction during the elective procedure.
authors: Interventional Cardiology Unit, Cardiology Department, "Sandro Pertini" Hospital, Rome, Italy. stefanorigattieri@yahoo.it
authors: Stefano
authors: S
authors: Rigattieri
authors: Giuseppe
authors: G
authors: Biondi-Zoccai
authors: Pasquale
authors: P
authors: Silvestri
authors: Cristian
authors: C
authors: Di Russo
authors: Carmine
authors: C
authors: Musto
authors: Giuseppe
authors: G
authors: Ferraiuolo
authors: Paolo
authors: P
authors: Loschiavo
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon / Q000009:adverse effects*; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000473:pathology* / Q000503:physiopathology; D003331:Coronary Vessels / Q000473:pathology*; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D012189:Retrospective Studies; D016896:Treatment Outcome