Multivessel Versus Culprit-only Percutaneous Coronary Intervention in ST-segment Elevation Acute Myocardial
Carlos Galvão Braga1, Ana Belén Cid-Álvarez2, Alfredo Redondo Diéguez2
1Servicio de Cardiología, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain; Serviço de Cardiologia, Hospital de Braga, Braga, Portugal.
Insights
Multivessel percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI) patients with multivessel disease significantly lowers mortality and major adverse cardiovascular events compared to culprit-only PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Myocardial Infarction Management
Background:
- Optimal treatment for multivessel coronary artery disease (CAD) in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) remains debated.
- Multivessel PCI versus culprit-lesion-only PCI strategies require further investigation in real-world settings.
Purpose of the Study:
- To evaluate the prognostic impact of multivessel PCI compared to culprit vessel-only PCI.
- To assess outcomes in real-world STEMI patients with multivessel CAD.
Main Methods:
- Retrospective cohort study of 1499 STEMI patients undergoing primary PCI (2008-2015).
- Propensity score matching created two groups (n=215 each) comparing multivessel PCI to culprit vessel-only PCI.
- Follow-up median duration was 2.36 years.
Main Results:
- Multivessel PCI was associated with significantly lower mortality rates (5.1% vs. 11.6%, P=.014).
- Lower rates of unplanned repeat revascularization (7.0% vs. 12.6%, P=.043) and major acute cardiovascular events (22.0% vs. 30.8%, P=.049) were observed with multivessel PCI.
- A trend towards lower myocardial infarction incidence was noted in the multivessel PCI group (4.2% vs. 6.1%, P=.360).
Conclusions:
- A strategy of multivessel PCI in STEMI patients with multivessel CAD is linked to improved clinical outcomes.
- Multivessel PCI demonstrated reduced mortality, repeat revascularization, and major adverse cardiovascular events in real-world practice.
Introduction And Objectives:
The optimal treatment of patients with multivessel coronary artery disease and ST-segment elevation acute myocardial infarction (STEMI) who undergo primary percutaneous coronary intervention (PCI) is controversial. The aim of this study was to access the prognostic impact of multivessel PCI vs culprit vessel-only PCI in real-world patients with STEMI and multivessel disease.
Methods:
This was a retrospective cohort study of 1499 patients with STEMI diagnosis who underwent primary PCI between January 2008 and December 2015. About 40.8% (n=611) patients had multivessel disease. We performed a propensity score matched analysis to obtain 2 groups of 215 patients paired according to whether or not they had undergone multivessel PCI or culprit vessel-only PCI.
Results:
During follow-up (median, 2.36 years), after propensity score matching, patients who underwent multivessel PCI had lower rates of mortality (5.1% vs 11.6%; Peto-Peto P=.014), unplanned repeat revascularization (7.0% vs 12.6%; Peto-Peto P=.043) and major acute cardiovascular events (22.0% vs 30.8%; Peto-Peto P=.049). These patients also showed a trend to a lower incidence of myocardial infarction (4.2% vs 6.1%; Peto-Peto P=.360).
Conclusions:
In real-world patients presenting with STEMI and multivessel coronary artery disease, a multivessel PCI strategy was associated with lower rates of mortality, unplanned repeat revascularization, and major acute cardiovascular events.
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