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Culprit vessel only versus "one-week" staged percutaneous coronary intervention for multivessel disease in patients
Li-Xiang Ma1, Zhen-Hua Lu1, Le Wang1
1Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Insights
A one-week staged multivessel percutaneous coronary intervention (PCI) significantly reduced deaths and major adverse cardiac events (MACE) compared to culprit-only PCI in ST-segment elevation myocardial infarction (STEMI) patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- Multivessel coronary artery disease (CAD) in ST-segment elevation myocardial infarction (STEMI) patients presents treatment challenges.
- The optimal revascularization strategy, specifically staged multivessel percutaneous coronary intervention (PCI) versus culprit-only PCI, remains an area of investigation.
Purpose of the Study:
- To compare the impact of a "one-week" staged multivessel PCI strategy against a culprit-only PCI approach.
- To evaluate differences in all-cause mortality and major adverse cardiac events (MACE) between these two treatment strategies.
Main Methods:
- Retrospective analysis of 447 STEMI patients with multivessel disease undergoing PCI.
- Two groups were compared: 201 patients receiving "one-week" staged multivessel PCI and 246 patients receiving culprit-only PCI.
- Follow-up data was collected until September 2014 to assess long-term outcomes.
Main Results:
- "One-week" staged multivessel PCI showed a significant reduction in 55-month all-cause death (6.5% vs. 16.7%) and MACE (19.9% vs. 33.3%) compared to culprit-only PCI.
- Staged multivessel PCI also led to fewer myocardial infarctions, coronary-artery bypass grafting (CABG), and repeat PCI procedures.
- No significant difference in stent thrombosis rates was observed between the two groups.
Conclusions:
- "One-week" staged multivessel PCI is a safe and effective revascularization strategy for STEMI patients with multivessel disease.
- This approach offers significant benefits in reducing long-term mortality and MACE compared to limiting intervention to the culprit lesion only.
Objective:
To explore the impact of a "one-week" staged multivessel percutaneous coronary intervention (PCI) versus culprit-only PCI on deaths and major adverse cardiac events (MACE).
Methods:
We retrospectively analyzed 447 patients with multivessel disease who experienced a ST-segment elevation myocardial infarction (STEMI) within 12 h before undergoing PCI between July 26, 2008 and September 25, 2011. After completion of PCI in the infarct artery, 201 patients still in the hospital agreed to undergo PCI in non-infarct arteries with more than 70% stenosis for a "one-week" staged multivessel PCI. A total of 246 patients only received intervention for the culprit vessel. Follow-up ended on September 9, 2014. This study examined the differences in deaths from any cause (i.e., cardiac and noncardiac) and MACE between the two treatment groups.
Results:
Compared to a culprit-only PCI treatment approach, the "one-week" staged multivessel PCI was strongly associated with greater benefits for 55-month all cause death [41 (16.7%) vs.13 (6.5%), P = 0.004] and MACE [82 (33.3%) vs. 40 (19.9%), P = 0.002] rates. In addition, there were significant differences in the number of myocardial infarctions [43 (17.5%) vs. 20 (10.0%), P = 0.023], coronary-artery bypass grafting [CABG; 20 (8.1%) vs. 6 (3.0%), P = 0.021], and PCI [31 (12.6%) vs. 12 (6.0%), P = 0.018]. Patients undergoing culprit-only PCI compared to "one-week" PCI had the same number of stent thrombosis events [7 (2.8%) vs. 3 (1.5%), P = 0.522].
Conclusions:
Compared to a culprit-only PCI treatment approach, "one-week" staged multi-vessel PCI was a safe and effective selection for STEMI and multi-vessel PCI.
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