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Published on: May 28, 2019
Optimal timing of staged percutaneous coronary intervention in ST-segment elevation myocardial infarction patients
Xue-Dong Zhao1, Guan-Qi Zhao1, Xiao Wang1
1Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China.
Insights
For ST-segment elevation myocardial infarction (STEMI) patients with multivessel disease, staged percutaneous coronary intervention (PCI) within two weeks of the initial procedure significantly reduces major adverse cardiovascular events (MACE). This timing is crucial for improving patient prognosis.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes
Background:
- Staged percutaneous coronary intervention (PCI) for non-culprit lesions improves outcomes in ST-segment elevation myocardial infarction (STEMI) patients with multivessel disease.
- The optimal timing for this staged PCI remains a critical, unresolved question in clinical practice.
Purpose of the Study:
- To determine the optimal time interval for performing staged PCI in STEMI patients with multivessel disease.
- To evaluate the impact of different staged PCI timings on major adverse cardiovascular events (MACE).
Main Methods:
- A cohort of 428 STEMI patients with multivessel disease undergoing primary and staged PCI were analyzed.
- Patients were stratified into three groups based on the interval between primary and staged PCI: ≤ 1 week, 1-2 weeks, and 2-12 weeks.
- Major adverse cardiovascular events (MACE), including death, re-infarction, repeat revascularization, and stroke, were tracked using Cox regression analysis.
Main Results:
- A statistically significant difference in MACE incidence was observed across the groups (P = 0.001), with rates of 23.0% (≤ 1 week), 33.0% (1-2 weeks), and 40.0% (2-12 weeks).
- Staged PCI performed within 1 week (HR: 0.40) and 1-2 weeks (HR: 0.54) after primary PCI was associated with a significantly lower risk of MACE compared to the 2-12 week interval.
- This reduction in MACE was primarily driven by a lower rate of repeat revascularization in the earlier staged PCI groups.
Conclusions:
- The optimal timing for staged PCI in non-culprit vessels for STEMI patients is within two weeks following the primary PCI.
- Performing staged PCI earlier, specifically within two weeks, is associated with improved clinical outcomes and reduced MACE.
Background:
Studies have shown that staged percutaneous coronary intervention (PCI) for non-culprit lesions is beneficial for prognosis of ST-segment elevation myocardial infarction (STEMI) patients with multivessel disease. However, the optimal timing of staged revascularization is still controversial. This study aimed to find the optimal timing of staged revascularization.
Methods:
A total of 428 STEMI patients with multivessel disease who underwent primary PCI and staged PCI were included. According to the time interval between primary and staged PCI, patients were divided into three groups (≤ 1 week, 1-2 weeks, and 2-12 weeks after primary PCI). The primary endpoint was major adverse cardiovascular events (MACE), a composite of all-cause death, non-fatal re-infarction, repeat revascularization, and stroke. Cox regression model was used to assess the association between staged PCI timing and risk of MACE.
Results:
During the follow-up, 119 participants had MACEs. There was statistical difference in MACE incidence among the three groups (≤ 1 week: 23.0%; 1-2 weeks: 33.0%; 2-12 weeks: 40.0%; P = 0.001). In the multivariable adjustment model, the timing interval of staged PCI ≤ 1 week and 1-2 weeks were both significantly associated with a lower risk of MACE [hazard ratio (HR): 0.40, 95% confidence intervals (CI): 0.24-0.65; HR: 0.54, 95% CI: 0.31-0.93, respectively], mainly attributed to a lower risk of repeat revascularization (HR: 0.41, 95% CI: 0.24-0.70; HR: 0.36, 95% CI: 0.18-0.7), compared with a strategy of 2-12 weeks later of primary PCI.
Conclusions:
The optimal timing of staged PCI for non-culprit vessels should be within two weeks after primary PCI for STEMI patients.
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