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Bleeding episodes in "complete, staged" versus "culprit only" revascularisation in patients with multivessel disease

Golnaz Sadjadieh1, Thomas Engstrøm, Steffen Helqvist

  • 1Department of Cardiology, Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark.

Eurointervention : Journal of Europcr in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
|November 21, 2016
PubMed

Insights

A staged complete revascularization strategy for ST-segment elevation myocardial infarction (STEMI) patients with multivessel disease does not increase serious bleeding events. This approach, involving a second in-hospital procedure, showed no significant difference in major bleeding compared to infarct-related artery PCI alone.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Clinical Trials

Background:

  • ST-segment elevation myocardial infarction (STEMI) is a critical condition requiring prompt treatment.
  • Multivessel disease in STEMI patients presents complex revascularization challenges.
  • The safety of complete revascularization strategies, particularly regarding bleeding risk, needs thorough evaluation.

Purpose of the Study:

  • To assess if a staged in-hospital complete revascularization strategy increases serious bleeding events in STEMI patients with multivessel disease.
  • To compare bleeding complications between complete revascularization and infarct-related artery (IRA)-only percutaneous coronary intervention (PCI).

Main Methods:

  • The DANAMI-3-PRIMULTI trial substudy randomized 627 STEMI patients with multivessel disease.
  • Patients were assigned to either IRA-only PCI or staged complete revascularization before discharge.
  • Bleeding events were assessed using Bleeding Academic Research Consortium (BARC) and Thrombolysis In Myocardial Infarction (TIMI) criteria.

Main Results:

  • No significant difference in TIMI major+minor bleedings related to primary PCI was observed.
  • No major or minor bleedings occurred in relation to the second procedure in the complete revascularization arm.
  • While minimal/medical attention bleedings were higher in the complete revascularization group (61.5% vs. 49.5%), there was no difference in admission time or one-year mortality.

Conclusions:

  • A staged complete in-hospital revascularization strategy for STEMI patients with multivessel disease does not elevate the risk of serious bleeding events.
  • Performing a second in-hospital procedure as part of complete revascularization is safe concerning major bleeding.
  • The findings support the safety of complete revascularization in selected STEMI patients, without compromising outcomes related to bleeding or mortality.
Abstract

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