An Observational Study Assessing Immediate Complete Versus Delayed Complete Revascularisation in Patients with...

Area of Science:

• Cardiology
• Interventional Cardiology
• Clinical Outcomes Research

Background:

• Over half of ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) have multi-vessel coronary artery disease (CAD).
• Multi-vessel CAD is linked to poorer prognoses compared to single-vessel disease.
• Optimal timing for revascularization of non-infarct-related arteries (bystander disease) in STEMI patients remains under investigation.

Purpose of the Study:

• To compare clinical outcomes between patients with STEMI and multi-vessel CAD who received complete revascularization as inpatients versus those undergoing staged PCI as early outpatients.

Main Methods:

• Observational cohort study of 1522 patients with STEMI and multi-vessel CAD (2012-2019), excluding those with cardiogenic shock or prior CABG.
• Patients were divided into inpatient complete revascularization or outpatient staged PCI groups.
• Primary outcome was major adverse cardiac events (MACE), including myocardial infarction, target vessel revascularization, and all-cause mortality.

Main Results:

• No significant differences in baseline or procedural characteristics between the inpatient (n=834) and outpatient (n=688) groups.
• Major adverse cardiac events (MACE) rates were similar between groups over follow-up (P = .62), persisting after multivariate adjustment (HR 1.21 [95% CI 0.72-1.96]).
• Propensity-matched analysis also showed no significant difference in outcomes (HR: 0.86 95% CI: 0.75-1.25).

Conclusions:

• The timing of bystander PCI in STEMI patients with multi-vessel CAD does not appear to affect cardiovascular outcomes.
• Early outpatient staged PCI following STEMI is a viable strategy.
• This approach may lead to a significant reduction in hospital length of stay.