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Acute Coronary Syndrome (ACS) encompasses a spectrum of heart conditions caused by sudden obstruction of coronary arteries, typically resulting from the rupture of an atherosclerotic plaque and subsequent thrombus (blood clot) formation. This obstruction can lead to partial or complete blockage of blood flow, causing varying degrees of myocardial ischemia or infarction.ACS includes the following clinical entities:Unstable Angina (UA)Non-ST-Elevation Myocardial Infarction (NSTEMI)ST-Elevation...
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IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
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Complete Revascularization and Survival in STEMI.

Miha Sustersic1, Miha Mrak1, Polona Svegl1

  • 1Department of Cardiology, University Medical Centre Ljubljana, Ljubljana, SI.

Global Heart
|October 25, 2021
PubMed
Summary

Complete revascularization (CR) in ST-elevation myocardial infarction (STEMI) patients with multivessel coronary artery disease (MVD) showed lower death rates initially. However, adjusted analysis revealed survival was independent of CR versus incomplete revascularization (IR).

Keywords:
STEMImultivessel diseaseoutcomespercutaneous coronary intervention

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Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Clinical Research

Background:

  • Complete revascularization (CR) in ST-elevation myocardial infarction (STEMI) patients with multivessel coronary artery disease (MVD) is associated with better combined endpoints compared to incomplete revascularization (IR).
  • Previous randomized control trials indicated no significant impact on survival between CR and IR.

Purpose of the Study:

  • To retrospectively evaluate the impact of complete revascularization (CR) during the index hospitalization on survival in STEMI patients with MVD.

Main Methods:

  • Retrospective analysis of STEMI patients with MVD who underwent primary percutaneous coronary intervention.
  • Coronary angiograms reviewed for non-culprit arteries treated with PCI.
  • Comparison of all-cause and cardiovascular death rates between CR (N=70) and IR (N=165) groups over a median follow-up of 7.0 years.

Main Results:

  • The CR group exhibited lower rates of all-cause death (15.7% vs 35.8%) and cardiovascular death (12.9% vs 23.6%) in unadjusted analysis.
  • Multivariable analysis adjusting for confounders showed no significant benefit of CR for all-cause death (HR 0.60) or cardiovascular death (HR 0.80).
  • Predictors of death included age, elevated creatinine, diabetes, and cardiogenic shock at presentation.

Conclusions:

  • While CR patients showed lower observed death rates, adjusted survival was independent of revascularization strategy.
  • Confounding factors, not the method of revascularization, were the primary determinants of long-term survival in STEMI patients with MVD.