title: Bleeding episodes in "complete, staged" versus "culprit only" revascularisation in patients with multivessel disease and ST-segment elevation myocardial infarction: a DANAMI-3-PRIMULTI substudy.
abstract: OBJECTIVE
  The aim of this study was to evaluate whether a staged in-hospital complete revascularisation strategy increases the risk of serious bleeding events in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease.
  
  
  RESULTS
  The DANAMI-3-PRIMULTI trial investigated whether a staged in-hospital complete revascularisation strategy improved outcome in patients with STEMI and multivessel disease. In this substudy, we investigated potential bleeding complications related to a second in-hospital procedure. Bleedings were assessed using BARC and TIMI criteria. Six hundred and twenty-seven (627) patients were randomised 1:1 to either PCI of the infarct-related artery (IRA) only (n=313) or complete revascularisation during a staged procedure before discharge (n=314). We found no significant difference in TIMI major+minor bleedings related to the primary PCI. There were neither major nor minor bleedings in relation to the second procedure in the complete revascularisation arm. There were significantly more in-hospital minimal+medical attention bleedings in the group randomised to complete revascularisation (61.5% vs. 49.5% in the IRA-PCI only group, p=0.003), but no difference in admission time or one-year mortality (2.2% complete revascularisation-group vs. 2.6% IRA-PCI only group, p=0.8).
  
  
  CONCLUSIONS
  In multivessel diseased STEMI patients, a staged complete in-hospital revascularisation strategy or any second in-hospital procedure did not result in an increase in serious bleeding events.
authors.affiliation: Department of Cardiology, Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Golnaz
authors.initials: G
authors.lastname: Sadjadieh
authors.forename: Thomas
authors.initials: T
authors.lastname: Engstrøm
authors.forename: Steffen
authors.initials: S
authors.lastname: Helqvist
authors.forename: Dan Eik
authors.initials: DE
authors.lastname: Høfsten
authors.forename: Lars
authors.initials: L
authors.lastname: Køber
authors.forename: Frants
authors.initials: F
authors.lastname: Pedersen
authors.forename: Peter
authors.initials: P
authors.lastname: Clemmensen
authors.forename: Erik
authors.initials: E
authors.lastname: Jørgensen
authors.forename: Kari
authors.initials: K
authors.lastname: Saunamäki
authors.forename: Hans-Henrik
authors.initials: HH
authors.lastname: Tilsted
authors.forename: Henning
authors.initials: H
authors.lastname: Kelbæk
authors.forename: Lene
authors.initials: L
authors.lastname: Holmvang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003324:Coronary Artery Disease / Q000628:therapy; D004562:Electrocardiography / Q000379:methods; D005260:Female; D006470:Hemorrhage / Q000150:complications / Q000453:epidemiology*; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods; D062645:Percutaneous Coronary Intervention / Q000379:methods; D000072657:ST Elevation Myocardial Infarction / Q000628:therapy*; D016896:Treatment Outcome