A randomised trial of target-vessel versus multi-vessel revascularisation in ST-elevation myocardial infarction: major adverse cardiac events during long-term follow-up.
BACKGROUND
Few reports described outcomes of complete compared with infarct-related artery (IRA)-only revascularisation in patients with ST-elevation myocardial infarction (STEMI) and multivessel coronary artery disease (CAD). Moreover, no studies have compared the simultaneous treatment of non-IRA with the IRA treatment followed by an elective procedure for the other lesions (staged revascularisation).


METHODS
The outcomes of 263 [corrected] consecutive patients with STEMI and multivessel CAD undergoing primary angioplasty were studied. Before the first angioplasty patients were randomly assigned to three different strategies: culprit vessel angioplasty-only (COR group); staged revascularisation (SR group) and simultaneous treatment of non-IRA (CR group).


RESULTS
During a mean follow-up of 2.5 years, 42 (50.0%) patients in the COR group experienced at least one major adverse cardiac event (MACE), 13 (20.0%) in the SR group and 15 (23.1%) in the CR group, p<0.001. Inhospital death, repeat revascularisation and re-hospitalisation occurred more frequently in the COR group (all p<0.05), whereas there was no significant difference in re-infarction among the three groups. Survival free of MACE was significantly reduced in the COR group but was similar in the CR and SR groups.


CONCLUSIONS
Culprit vessel-only angioplasty was associated with the highest rate of long-term MACE compared with multivessel treatment. Patients scheduled for staged revascularisation experienced a similar rate of MACE to patients undergoing complete simultaneous treatment of non-IRA.
Politi
Luigi
L
Institute of Cardiology, Policlinico University Hospital, Via del Pozzo 71, Modena 41100, Italy. luigi.politi@unimore.it
Sgura
Fabio
F
Rossi
Rosario
R
Monopoli
Daniel
D
Guerri
Elisa
E
Leuzzi
Chiara
C
Bursi
Francesca
F
Sangiorgi
Giuseppe Massimo
GM
Modena
Maria Grazia
MG
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D023921:Coronary Stenosis / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009203:Myocardial Infarction / Q000601:surgery*; D009204:Myocardial Revascularization / Q000379:methods*; D012008:Recurrence; D019233:Retreatment / Q000706:statistics & numerical data; D016896:Treatment Outcome