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Updated: Feb 13, 2026
Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Major adverse cardiovascular events while awaiting staged non-culprit percutaneous coronary intervention after
Keir McCutcheon1, Andreas S Triantafyllis1, Thomas Marynissen1
1a Department of Cardiovascular Medicine , University Hospitals Leuven , Leuven , Belgium.
Insights
For ST-segment elevation myocardial infarction (STEMI) patients with multi-vessel disease (MVD), a staged revascularisation (SR) strategy shows a low rate of major adverse cardiovascular events (MACE) during the waiting period. This approach offers excellent long-term outcomes compared to immediate complete revascularisation.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- Optimal treatment for ST-segment elevation myocardial infarction (STEMI) with multi-vessel disease (MVD) is debated.
- Complete revascularisation (CR) is increasingly supported, but timing (index vs. staged admission) is unclear.
- Assessing safety of delayed CR in STEMI with MVD is crucial.
Purpose of the Study:
- To evaluate major adverse cardiovascular events (MACE) during the waiting period for staged revascularisation (SR) in STEMI patients with MVD.
- To compare outcomes of SR versus in-hospital complete revascularisation (CR) in this patient group.
Main Methods:
- Retrospective analysis of 931 STEMI patients treated with primary percutaneous coronary intervention (PCI).
- Identified 397 patients with MVD, haemodynamically stable, presenting within 12 hours.
- Compared outcomes for 49 patients undergoing in-hospital CR versus 142 patients undergoing SR.
Main Results:
- Waiting period MACE in SR group was 2% (3/142) at a median of 31 days.
- 30-day MACE in in-hospital CR group was 10% (5/49).
- Long-term follow-up (39 months) showed lower all-cause mortality (7.0% vs. 28.6%) and cardiac mortality (2% vs. 8%) in SR vs. CR groups.
Conclusions:
- STEMI patients with MVD allocated to SR experienced minimal adverse events during the waiting period.
- Staged revascularisation demonstrated favourable long-term outcomes in selected STEMI patients with MVD.
- Clinical judgement supports SR as a safe and effective strategy for selected STEMI patients with MVD.
Background:
The optimal therapeutic strategy for ST-segment elevation myocardial infarction (STEMI) patients found to have multi-vessel disease (MVD) is controversial but recent data support complete revascularisation (CR). Whether CR should be completed during the index admission or during a second staged admission remains unclear. Our main objective was to measure rates of major adverse cardiovascular events (MACEs) during the waiting period in STEMI patients selected for staged revascularisation (SR), in order to determine the safety of delaying CR. For completeness, we also describe 30-day and long-term outcomes in STEMI patients with MVD who underwent in-hospital CR.
Methods:
A single-centre retrospective analysis of 931 STEMI patients treated by primary percutaneous coronary intervention (PCI) identified 397 patients with MVD who were haemodynamically stable and presented within 12 hours of chest pain onset. Of these, 191 underwent multi-vessel PCI: 49 during the index admission and 142 patients undergoing a strategy of SR.
Results:
Our main finding was that waiting period MACE were 2% (three of 142) in patients allocated to SR (at a median of 31 days). In patients allocated to in-hospital CR, 30-day MACE rates were 10% (five of 49). During a median follow up of 39 months, all-cause mortality was 7.0% vs. 28.6%, and cardiac mortality was 2% vs. 8%, in patients allocated to SR or CR, respectively.
Conclusions:
Patients with STEMI and MVD who, based on clinical judgement, were allocated to a second admission SR strategy had very few adverse events during the waiting period and excellent long-term outcomes.
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