Timing of Nonculprit Percutaneous Coronary Intervention after ST-Elevation Myocardial Infarction
Joshua H Arnold1,2, Tamir Bental1,2, Gabriel Greenberg1,2
1Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel.
Insights
Delaying staged percutaneous coronary intervention (PCI) for nonculprit lesions in ST-elevation myocardial infarction (STEMI) patients with multivessel disease (MVD) increases the risk of major adverse cardiac events (MACE). Optimal timing for staged PCI is crucial for better patient outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Complete revascularization in ST-elevation myocardial infarction (STEMI) patients with multivessel disease (MVD) reduces adverse cardiovascular events.
- The optimal timing for revascularizing nonculprit lesions remains a critical clinical question.
Purpose of the Study:
- To evaluate the association between the time interval to staged percutaneous coronary intervention (sPCI) and major adverse cardiac events (MACE) in STEMI patients with MVD.
Main Methods:
- A prospective registry of 3,002 STEMI patients treated with primary PCI (pPCI) was analyzed.
- 1,555 patients with MVD requiring sPCI were categorized into quartiles based on the duration between pPCI and sPCI (0-7 days, 7-22 days, 22-42 days, >42 days).
- Cox regression and propensity score matching were used to assess MACE, including all-cause mortality, myocardial infarction, target vessel revascularization, and coronary artery bypass surgery.
Main Results:
- MACE rates increased with longer delays to sPCI: 16.5% (0-7 days), 21.2% (7-22 days), 25.8% (22-42 days), and 30.1% (>42 days).
- Staged PCI was an independent risk factor for MACE (HR=1.226, p<0.001).
- No significant association was found between the time interval to sPCI and all-cause death.
Conclusions:
- Patients with MVD undergoing sPCI for nonculprit lesions face a higher risk of MACE as the delay from primary PCI increases.
- These findings underscore the importance of timely intervention for nonculprit lesions in STEMI patients with MVD.
Introduction:
Complete revascularization of ST-elevation myocardial infarction (STEMI) patients with multivessel disease (MVD) has recently shown to reduce risk of adverse cardiovascular events, including cardiovascular death. Optimal timing of revascularization of nonculprit lesions remains controversial. We aimed to measure cardiac outcomes related to duration between primary percutaneous coronary intervention (pPCI) of the culprit lesion and staged PCI (sPCI) of nonculprit lesions.
Methods:
From a prospectively collected consecutive registry of 3,002 patients treated for STEMI by pPCI, 1,555 patients with MVD requiring sPCI were identified. Patients were placed into quartiles of duration to sPCI: 0-7 days (Q1), 7-22 days (Q2), 22-42 days (Q3), >42 days (Q4), excluding those who had complete revascularization at the index event. Major adverse cardiac events (MACEs) included all-cause mortality, myocardial infarction, target vessel revascularization, and coronary artery bypass surgery. Cox regression and propensity score matching were performed correcting for confounding factors.
Results:
The average age at presentation was 65.7 ± 11.5 years. 333 were female (21.4%). Mean time between pPCI and sPCI was 28.3 days (±24.8). Rates of MACE were Q1 - 16.5%, Q2 - 21.2%, Q3 - 25.8%, and Q4 - 30.1% (log-rank <0.001). Following regression analysis, sPCI remained an independent risk factor for MACE (hazard ratio [HR] = 1.226 [95% confidence interval {CI}: 1.129-1.331, p < 0.001]). There was no association between the time interval up to sPCI with all-cause death (HR = 1.022 [95% CI: 0.925-1.129, p = 0.671]).
Conclusions:
Patients with MVD are at increased risk of experiencing MACE after revascularization of nonculprit vessels with increasing time delay between pPCI and sPCI.
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