Early angio-guided complete revascularization versus culprit vessel PCI followed by ischemia-guided staged PCI in STEMI patients with multivessel disease.
BACKGROUND
Optimal management of multivessel disease (MVD) in ST-segment elevation myocardial infarction (STEMI) patients treated by primary percutaneous coronary intervention (PCI) is still unclear.


OBJECTIVE
To compare short- and long-term clinical outcomes of early-staged, angio-guided approach and delayed, ischemia-guided treatment of non-infarct-related arteries (IRAs).


METHODS
Consecutive patients with STEMI and MVD treated with primary PCI in 6 tertiary care centers were retrospectively selected and analyzed. Major adverse cardiac events (MACE) were defined as the composite end-point of death, MI, and repeat revascularization. All the events were adjudicated according to the Academic Research Consortium (ARC) definitions.


RESULTS
In the time period 2004-2008, 800 primary PCIs in STEMI patients with MVD were performed. Four hundred and seventeen were addressed to early-staged, angio-guided PCI of non-IRAs (CR group) and 383 to an incomplete revascularization (IncR group). During the hospital stay, no difference in terms of death and repeat revascularization was found between groups but the incidence of periprocedural MI/reinfarction and MACE was significantly higher in the CR group (13.9% vs. 3.1%, P = 0.01 and 14.1% vs. 9.1%, P = 0.017, respectively). At a mean follow-up of 642 ± 545 days, no difference in terms of death and MI was found between the CR and IncR group. The MACE-free survival was significantly higher in the IncR group (73.8% vs. 57%, log rank 0.05), mainly driven by the lower incidence of re-PCI.


CONCLUSIONS
Early complete revascularization based only on angiographic findings in patients with STEMI and MVD is associated with an excess of periprocedural/re-MI and with a significantly higher incidence of MACE at follow-up.
Interventional Cardiology Unit, A.O. Ordine Mauriziano Umberto I, Turin, Italy. emeliga@gmail.com
Emanuele
E
Meliga
Claudia
C
Fiorina
Marco
M
Valgimigli
Riccardo
R
Belli
Andrea
A
Gagnor
Imad
I
Sheiban
Chiara
C
Resmini
Emanuele
E
Tizzani
Tiziana
T
Aranzulla
Innocenzo
I
Scrocca
Mauro
M
DE Benedictis
Maria Rosa
MR
Conte
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000401:mortality / Q000706:statistics & numerical data; D016001:Confidence Intervals; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000473:pathology; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D013223:Statistics as Topic; D013318:Stroke Volume; D013997:Time Factors; D016277:Ventricular Function, Left