title: Comparison of Outcomes of Staged Complete Revascularization Versus Culprit Lesion-Only Revascularization for ST-Elevation Myocardial Infarction and Multivessel Coronary Artery Disease.
abstract: The management of noninfarct-related arteries in patients with ST-elevation myocardial infarction (STEMI) and multivessel coronary disease (MVD) is still debated. We evaluated the prognostic impact of staged complete revascularization with percutaneous coronary intervention (PCI) in STEMI patients with MVD admitted to our hospital from 2005 to 2013. Patients undergoing staged complete revascularization (n = 300) were compared with 1:1 propensity score-matched patients with culprit lesion-only treatment (n = 300). We considered a composite primary end point of all-cause death, myocardial infarction, and urgent PCI. Secondary end points included components of the primary, cardiovascular death, any PCI excluding staged PCI. We also performed an analysis including only patients surviving at least 5 days. The median follow-up was 553 days. The primary end point occurred in 10.3% of patients in the staged complete revascularization group and in 16.3% of patients in the culprit lesion-only group (hazard ratio 0.61, 95% CI 0.38 to 0.95, p = 0.031). Although this difference was no longer significant when considering only the survivors at day 5, all-cause and cardiovascular mortalities were still reduced in the staged complete revascularization group. Complete revascularization was associated with a better outcome (hazard ratio 0.35, 95% CI 0.17 to 0.63, p = 0.005) if performed within 30 days of STEMI. In conclusion, compared with culprit lesion-only revascularization, in STEMI patients with MVD undergoing primary PCI, an approach of staged complete revascularization was associated with a better outcome.
authors.affiliation: Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Molecular Medicine, University of Pavia, Pavia, Italy.
authors.forename: Marcello
authors.initials: M
authors.lastname: Marino
authors.affiliation: Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Crimi
authors.affiliation: Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Coronary Care Unit and Laboratory for Clinical and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Leonardi
authors.affiliation: Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Ferlini
authors.affiliation: Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Repetto
authors.affiliation: Coronary Care Unit and Laboratory for Clinical and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: Rita
authors.initials: R
authors.lastname: Camporotondo
authors.affiliation: Department of Molecular Medicine, University of Pavia, Pavia, Italy; Coronary Care Unit and Laboratory for Clinical and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Demarchi
authors.affiliation: Department of Molecular Medicine, University of Pavia, Pavia, Italy; Coronary Care Unit and Laboratory for Clinical and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: De Pascali
authors.affiliation: Department of Molecular Medicine, University of Pavia, Pavia, Italy; Coronary Care Unit and Laboratory for Clinical and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Falcinella
authors.affiliation: Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Oltrona Visconti
authors.affiliation: Department of Molecular Medicine, University of Pavia, Pavia, Italy; Coronary Care Unit and Laboratory for Clinical and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: De Servi
authors.affiliation: Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Ferrario
authors.affiliation: Department of Molecular Medicine, University of Pavia, Pavia, Italy; Coronary Care Unit and Laboratory for Clinical and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. Electronic address: g.deferrari@smatteo.pv.it.
authors.forename: Gaetano Maria
authors.initials: GM
authors.lastname: De Ferrari
authors.affiliation: Department of Molecular Medicine, University of Pavia, Pavia, Italy; Coronary Care Unit and Laboratory for Clinical and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Medicine, University of Cape Town, Cape Town, South Africa.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Gnecchi
mesh_terms: D000368:Aged; D002423:Cause of Death; D003324:Coronary Artery Disease / Q000601:surgery*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009026:Mortality; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D057216:Propensity Score; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D000072657:ST Elevation Myocardial Infarction / Q000601:surgery*