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Culprit-only versus staged complete revascularization for patients with ST-segment elevation myocardial infarction

Tongtong Yu1, Yuanyuan Dong1, Jiahe Zhu1

  • 1Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China.

BMC Cardiovascular Disorders
|October 8, 2016
PubMed

Insights

For ST-segment elevation myocardial infarction (STEMI) patients with multivessel disease (MVD), staged complete revascularization significantly lowers cardiac mortality or reinfarction rates compared to culprit-only treatment.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Clinical Research

Background:

  • Multivessel disease (MVD) is prevalent in ST-segment elevation myocardial infarction (STEMI) patients.
  • Optimal management strategies for STEMI patients with MVD are not well-defined.

Purpose of the Study:

  • To compare the clinical outcomes of staged complete revascularization versus culprit-only revascularization in STEMI patients with MVD.

Main Methods:

  • Retrospective cohort study of 602 STEMI patients with MVD.
  • Patients were divided into two groups: culprit-only revascularization (382 patients) and staged complete revascularization (220 patients).
  • Primary endpoints included cardiac mortality or nonfatal reinfarction.

Main Results:

  • Staged complete revascularization was associated with a significantly lower rate of cardiac mortality or nonfatal reinfarction (HR: 0.430, P=0.034).
  • Unplanned repeat revascularization rates were also significantly lower in the staged complete revascularization group (HR: 0.343, P=0.004).
  • Mean follow-up duration was 35 months.

Conclusions:

  • Staged complete revascularization significantly reduces the composite of cardiac mortality or nonfatal reinfarction in STEMI patients with MVD.
  • This approach also decreases the need for unplanned repeat revascularization compared to culprit-only revascularization.
Abstract

Keywords:
Multivessel diseaseRevascularizationST-segment elevation myocardial infarction

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