Complete Revascularization Versus Treatment of the Culprit Artery Only in ST Elevation Myocardial Infarction: A
Julia Cremona Cadore1, Mariana Vargas Furtado2, Rogério Tumelero3
1Universidade Federal do Rio Grande do Sul - PPG Ciências Cardiovasculares: Cardiologia, Porto Alegre, RS - Brasil.
Insights
Complete revascularization significantly reduces adverse outcomes in ST-segment elevation myocardial infarction (STEMI) patients with multivessel disease. This strategy improves prognosis compared to treating only the culprit artery, offering better long-term results.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Research
Background:
- Limited data exists on ST-segment elevation myocardial infarction (STEMI) management and prognosis in Brazil.
- Investigating revascularization strategies for STEMI patients with multivessel disease is crucial.
Purpose of the Study:
- To compare outcomes of complete revascularization versus culprit-only artery treatment in STEMI patients with multivessel disease.
- To evaluate the effectiveness of different revascularization approaches in a Brazilian cohort.
Main Methods:
- Prospective cohort study with 1-year follow-up at two Brazilian medical centers.
- Primary outcome: composite of cardiac death, reinfarction, or recurrent angina.
- Secondary outcomes: stroke, cardiac arrest, bleeding, reintervention.
Main Results:
- Complete revascularization (68.2%) was performed in 85 patients (mean age 62±12 years, 71.8% male).
- Incomplete revascularization was associated with significantly higher odds of primary (OR 5.1) and secondary (OR 5.2) outcomes.
- Cardiac death odds were also significantly higher with incomplete revascularization (OR 6.4).
Conclusions:
- Complete revascularization significantly reduces adverse outcomes in STEMI patients with multivessel disease.
- The findings support complete revascularization as a superior strategy for improving 1-year prognosis in this patient group.
- Registry data from Brazil highlights the benefits of comprehensive revascularization.
Background:
Data on the management and prognosis of patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease are limited in Brazil, showing that the available revascularization strategies should be investigated.
Objective:
To assess the outcomes of complete revascularization versus treatment of the culprit artery only in patients with STEMI and multivessel disease.
Methods:
A prospective cohort study was conducted at two medical centers in southern Brazil with a 1-year follow-up after the index procedure. The primary outcome was a composite of cardiac death, reinfarction, or recurrent angina, while the secondary outcome was stroke, nonfatal cardiac arrest, major bleeding, or need for reintervention. The probability of outcomes occurring was compared between the groups using binary logistic regression. A p-value < 0.05 was considered statistically significant.
Results:
Eighty-five patients were included. Their mean age was 62±12 years, and 61 (71.8%) were male. Fifty-eight (68.2%) were treated with complete revascularization and 27 (31.8%) with incomplete revascularization. The chance of both the primary and secondary outcomes occurring was significantly greater among patients treated with incomplete revascularization when compared to those treated with complete revascularization (odds ratio [OR] 5.1, 95% confidence interval [CI] 1.6-16.1 vs. OR 5.2, 95% CI 1.2-22.9, respectively), as well as cardiac death (OR 6.4, 95% CI 1.2-35.3).
Conclusion:
Registry data from two centers in southern Brazil demonstrate that the complete revascularization strategy is associated with a significant reduction in primary and secondary outcomes in a 1-year follow-up when compared to the incomplete revascularization strategy (Arq Bras Cardiol. 2020; 115(2):229-237).
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