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Optimal Timing of Percutaneous Coronary Intervention for Nonculprit Vessel in Patients with ST-Segment Elevation
Inna Kim1, Min Chul Kim1, Hae Chang Jeong1
1Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, Korea.
Insights
For ST-segment elevation myocardial infarction (STEMI) patients with multivessel disease (MVD), delaying staged percutaneous coronary intervention (PCI) beyond one week increases major adverse cardiac events (MACE). Simultaneous or early PCI within one week is associated with comparable safety outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Myocardial Infarction Research
Background:
- Optimal timing for staged percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI) patients with multivessel disease (MVD) is not well-defined.
- Multivessel PCI strategies are crucial for managing STEMI patients with complex coronary artery disease.
Purpose of the Study:
- To evaluate the impact of different timings of staged PCI on major adverse cardiac events (MACE) in STEMI patients with MVD.
- To compare outcomes between simultaneous, early (<1 week), and deferred (>1 week) staged PCI.
Main Methods:
- Retrospective analysis of 753 STEMI patients with MVD undergoing multivessel PCI.
- Patients categorized into three groups: simultaneous PCI, staged PCI within 1 week, and staged PCI after 1 week.
- Follow-up for major adverse cardiac events (MACE) including mortality, non-fatal myocardial infarction, and repeat PCI over 3.4 years.
Main Results:
- Deferred staged PCI after one week was associated with significantly higher MACE compared to simultaneous PCI (OR: 1.83, p=0.031).
- No significant difference in MACE was observed between simultaneous PCI and early staged PCI within one week (OR: 1.01, p=0.950).
- Independent predictors of 3-year MACE included high Killip class, left ventricular ejection fraction <45%, and deferred staged PCI (group 3).
Conclusions:
- Deferred staged PCI beyond one week in STEMI patients with MVD is linked to an increased risk of MACE.
- Both simultaneous multivessel PCI and early staged PCI (<1 week) demonstrate comparable safety profiles regarding MACE.
- Clinical decisions regarding staged PCI timing should consider patient factors and potential risks.
Background And Objectives:
In patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease (MVD), the optimal timing of staged percutaneous coronary intervention (PCI) remains unclear.
Subjects And 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).
Conclusion:
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.
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