Optimal Timing of Percutaneous Coronary Intervention for Nonculprit Vessel in Patients with ST-Segment Elevation Myocardial Infarction and Multivessel Disease.
OBJECTIVE
In patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease (MVD), the optimal timing of staged percutaneous coronary intervention (PCI) remains unclear.


METHODS
This study was a retrospective analysis of 753 STEMI patients with MVD who were treated by multivessel PCI in the Convergent Registry of Catholic and Chonnam University for Acute myocardial infarction (MI). Patients were divided into 3 groups according to the time from initial to staged PCI: group 1 (n=316, multivessel PCI performed during the index procedure), group 2 (n=360, staged PCI within 1 week), and group 3 (n=77, staged PCI after 1 week). The endpoint was major adverse cardiac events (MACEs), including all-cause mortality, non-fatal MI, and repeat PCI during 3.4 years follow-up.


RESULTS
The incidence of composite MACEs was higher in group 3 than in group 1 (odds ratio [OR]: 1.83, 95% confidence interval [CI]: 1.06 to 3.18, p=0.031). However, the risk of MACEs in groups 1 and 2 was comparable (OR: 1.01, 95% CI: 0.70 to 1.46, p=0.950). In multivariate logistic regression, independent predictors of 3-year MACEs were high Killip class (OR: 2.72, 95% CI: 1.38 to 5.37, p=0.004), left ventricular ejection fraction <45% (OR: 1.57, 95% CI: 1.06 to 2.32, p=0.024), and group 3 (OR: 1.83, 95% CI: 1.06 to 3.18, p=0.009).


CONCLUSIONS
Deferred staged PCI after one week index PCI was associated with the highest MACE, as compared to both simultaneous multivessel PCI and early staged PCI <1 week.
Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, Korea.
Inna
I
Kim
Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, Korea.
Min Chul
MC
Kim
Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, Korea.
Hae Chang
HC
Jeong
Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, Korea.
Keun Ho
KH
Park
Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, Korea.
Doo Sun
DS
Sim
Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, Korea.
Young Joon
YJ
Hong
Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, Korea.
Ju Han
JH
Kim
Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, Korea.
Myung Ho
MH
Jeong
Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, Korea.
Jeong Gwan
JG
Cho
Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, Korea.
Jong Chun
JC
Park
Department of Cardiology, Cardiovascular Center, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
Ki-Bae
KB
Seung
Department of Cardiology, Cardiovascular Center, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
Kiyuk
K
Chang
Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, Korea.
Youngkeun
Y
Ahn
Myocardial infarction; Percutaneous coronary intervention