Complete Revascularization with Multivessel PCI for Myocardial Infarction

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiovascular Medicine

Background:

• ST-segment elevation myocardial infarction (STEMI) patients with multivessel coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) of the culprit lesion have reduced risks of death or myocardial infarction.
• The benefit of performing PCI on non-culprit lesions in addition to the culprit lesion remains unclear.

Purpose of the Study:

• To determine if complete revascularization, including PCI of significant non-culprit lesions, further reduces the risk of adverse cardiovascular events in STEMI patients with multivessel CAD compared to culprit-lesion-only PCI.

Main Methods:

• A randomized trial assigned STEMI patients with multivessel CAD and successful culprit-lesion PCI to either complete revascularization or culprit-lesion-only PCI.
• Randomization was stratified by the timing of non-culprit lesion PCI (during or after index hospitalization).
• Primary endpoints included the composite of cardiovascular death or myocardial infarction, and cardiovascular death, myocardial infarction, or ischemia-driven revascularization.

Main Results:

• At 3-year follow-up, complete revascularization significantly reduced the first coprimary outcome (cardiovascular death or MI) (7.8% vs. 10.5%, HR 0.74, P=0.004).
• The second coprimary outcome (cardiovascular death, MI, or ischemia-driven revascularization) was also significantly reduced (8.9% vs. 16.7%, HR 0.51, P<0.001).
• Benefits were consistent regardless of the timing of non-culprit lesion PCI.

Conclusions:

• Complete revascularization in STEMI patients with multivessel CAD is superior to culprit-lesion-only PCI in reducing major adverse cardiovascular events.
• This strategy significantly lowers the risk of cardiovascular death, myocardial infarction, and the need for ischemia-driven revascularization.