title: Long-term outcome in patients with ST segment elevation myocardial infarction and multivessel disease treated with culprit-only, immediate, or staged multivessel percutaneous revascularization strategies: Insights from the REAL registry.
abstract: OBJECTIVE
  To examine the differences in cardiac outcomes for patients with ST-elevation myocardial infarction (STEMI) and multivessel disease (MVD) as a function of whether they underwent culprit-only primary percutaneous coronary intervention (PPCI) or multivessel PCI, either during PPCI or as a staged procedure.
  
  
  BACKGROUND
  MVD occurs in about 40% of patients presenting with STEMI, and it has been associated with a worse outcome compared to single-vessel disease. The most favorable PCI strategy for dealing with significant nonculprit lesions has to be established.
  
  
  METHODS
  A total of 2061 STEMI patients with MVD undergoing PPCI, prospectively enrolled in the REAL Registry between July 2002 and December 2010, were considered: 706 underwent culprit-only PPCI; 367 multivessel PCI during the index procedure; 988 had a staged PCI within 60 days. Mortality and outcomes were calculated at 30 days and 2 years.
  
  
  RESULTS
  At multivariate analysis, culprit-only PPCI was associated with higher rates of cardiac outcomes as compared to staged multivessel PCI, taken as reference [Hazard Ratio (HR): 2.81, 95% confidence interval (CI): 1.34-5.89, P = 0.006 for 30-day mortality, and HR: 1.93, 95% CI: 1.35-2.74, P = 0.0002 for 2-year mortality, respectively]. Short-term mortality rates were higher in multivessel PCI group as compared to staged PCI group (HR: 2.58, 95% CI: 1.06-6.26, P = 0.03); no differences were observed at 2-year follow-up (HR: 1.08, 95% CI: 0.64-1.82, P = 0.76).
  
  
  CONCLUSIONS
  Our findings support the current guidelines recommendation to perform culprit-only PPCI in STEMI patients with MVD without hemodynamic compromise, followed by a staged PCI of noninfarct-related significant lesions.
authors.affiliation: Interventional Cardiology Unit, Azienda Ospedaliera S. Maria Nuova - IRCCS, Reggio Emilia, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Manari
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Varani
authors.forename: Paolo
authors.initials: P
authors.lastname: Guastaroba
authors.forename: Mila
authors.initials: M
authors.lastname: Menozzi
authors.forename: Marco
authors.initials: M
authors.lastname: Valgimigli
authors.forename: Alberto
authors.initials: A
authors.lastname: Menozzi
authors.forename: Paolo
authors.initials: P
authors.lastname: Magnavacchi
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Franco
authors.forename: Antonio
authors.initials: A
authors.lastname: Marzocchi
authors.forename: Gianni
authors.initials: G
authors.lastname: Casella
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: acute myocardial infarction; angioplasty; coronary artery disease; stent