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STEMI and Multivessel Disease: Medical Therapy Amplifies the Benefit of Complete Myocardial Revascularisation

Enrico Fabris1, Andrea Pezzato1, Caterina Gregorio2

  • 1Cardiovascular Department, University of Trieste, Trieste, Italy.

Heart, Lung & Circulation
|August 16, 2021
PubMed

Insights

For ST-elevation myocardial infarction (STEMI) patients with multivessel disease (MVD), staged non-culprit revascularisation significantly reduced cardiovascular death compared to culprit-lesion-only PCI. Medical therapy further improved outcomes, amplifying revascularisation benefits.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Clinical Research

Background:

  • ST-elevation myocardial infarction (STEMI) patients with multivessel disease (MVD) present complex treatment challenges.
  • Optimal revascularisation strategies and prognostic predictors in MVD patients remain incompletely understood.
  • This study investigates the comparative effectiveness of different revascularisation approaches and the role of medical therapy.

Purpose of the Study:

  • To evaluate the prognostic impact of staged non-culprit revascularisation versus culprit-lesion-only percutaneous coronary intervention (PCI) in STEMI patients with MVD.
  • To assess the influence of medical therapy on cardiovascular outcomes in this patient population.
  • To identify predictors of improved outcomes following revascularisation strategies.

Main Methods:

  • Propensity score analysis was employed to compare two treatment strategies: staged non-culprit revascularisation and culprit-lesion-only PCI.
  • The composite endpoint included cardiovascular death (CVD), myocardial infarction, and repeat revascularisation.
  • Models were adjusted for medications at discharge, including renin-angiotensin inhibitors and beta-blockers.

Main Results:

  • In 433 STEMI patients with MVD, staged non-culprit revascularisation was associated with a significantly lower composite endpoint (HR 0.44), lower CVD (HR 0.34), and lower all-cause death (HR 0.46) after propensity-score adjustment.
  • Renin-angiotensin inhibitors use correlated with reduced CVD (HR 0.51) and all-cause death (HR 0.52).
  • Beta-blocker use was also linked to lower all-cause death (HR 0.48).

Conclusions:

  • Staged non-culprit revascularisation demonstrates superior outcomes regarding cardiovascular mortality compared to culprit-only PCI in STEMI patients with MVD.
  • Both revascularisation strategy and comprehensive medical therapy are crucial for improving mortality outcomes.
  • Medical therapy acts synergistically with myocardial revascularisation, enhancing its beneficial effects on patient survival.
Abstract

Keywords:
Beta blockersNon-culprit lesionPCIRenin-angiotensin system inhibitorsSTEMI

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