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Published on: May 28, 2019
Complete Versus Culprit-Only Revascularization for ST-Segment Elevation Myocardial Infarction and Multivessel Disease
Sung Woo Kwon1, Sang Don Park2, Jeonggeun Moon3
1Department of Cardiology, Inha University Hospital, Incheon, Korea.
Insights
Complete revascularization (CR) significantly reduced major adverse cardiovascular events (MACE) and cardiovascular death in ST-segment elevation myocardial infarction (STEMI) patients with multivessel disease (MVD). This approach using second-generation drug-eluting stents (DES) proved superior to culprit-only PCI over one year.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Research
Background:
- ST-segment elevation myocardial infarction (STEMI) often presents with multivessel disease (MVD).
- Optimal revascularization strategy in STEMI with MVD using second-generation drug-eluting stents (DES) remains debated.
- Comparing complete revascularization (CR) versus culprit-only revascularization is crucial for patient outcomes.
Purpose of the Study:
- To compare the clinical outcomes of CR versus culprit-only revascularization in STEMI patients with MVD.
- To evaluate the efficacy of second-generation DES in different revascularization strategies.
- To assess the impact on major adverse cardiovascular events (MACE) and cardiovascular death.
Main Methods:
- A cohort study of 705 patients with STEMI and MVD from 2009-2014.
- Patients underwent primary percutaneous coronary intervention (PCI) with second-generation DES.
- CR involved PCI of all diseased vessels; culprit-only involved PCI of the infarct-related artery only.
Main Results:
- Complete revascularization (CR) was performed in 59% of patients, while 41% received culprit-only PCI.
- CR group showed significantly lower MACE rates (11.5% vs. 18.5%) compared to culprit-only PCI.
- Cardiovascular death was also significantly lower in the CR group (7.2% vs. 12.9%).
Conclusions:
- Complete revascularization (CR) is associated with improved outcomes in STEMI patients with MVD treated with second-generation DES.
- CR significantly reduces MACE and cardiovascular death at one-year follow-up compared to culprit-only PCI.
- These findings support CR as a preferred strategy in selected STEMI patients with MVD.
Background And Objectives:
We aimed to compare outcomes of complete revascularization (CR) versus culprit-only revascularization for ST-segment elevation myocardial infarction (STEMI) and multivessel disease (MVD) in the 2nd generation drug-eluting stent (DES) era.
Methods:
From 2009 to 2014, patients with STEMI and MVD, who underwent primary percutaneous coronary intervention (PCI) using a 2nd generation DES for culprit lesions were enrolled. CR was defined as PCI for a non-infarct-related artery during the index admission. Major adverse cardiovascular event (MACE) was defined as cardiovascular (CV) death, non-fatal myocardial infarction, target lesion revascularization, or heart failure during the follow-up year.
Results:
In total, 705 MVD patients were suitable for the analysis, of whom 286 (41%) underwent culprit-only PCI and 419 (59%) underwent CR during the index admission. The incidence of MACE was 11.5% in the CR group versus 18.5% in the culprit-only group (hazard ratio [HR], 0.56; 95% confidence interval [CI], 0.37-0.86; p<0.01; adjusted HR, 0.64; 95% CI, 0.40-0.99; p=0.04). The CR group revealed a significantly lower incidence of CV death (7.2% vs. 12.9%; HR, 0.51; 95% CI, 0.31-0.86; p=0.01 and adjusted HR, 0.57; 95% CI; 0.32-0.97; p=0.03, respectively).
Conclusions:
CR was associated with better outcomes including reductions in MACE and CV death at 1 year of follow-up compared with culprit-only PCI in the 2nd generation DES era.
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