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Revascularization strategies in STEMI and multivessel disease
Inês Almeida1, Joana Chin1, Hélder Santos1
1Cardiology Departement, Barreiro-Montijo Hospital Center, Portugal.
Insights
Complete revascularization (CR) in ST-elevation myocardial infarction (STEMI) patients with multivessel disease (MVD) significantly reduces mortality and major adverse cardiovascular events (MACE). This strategy is particularly beneficial for hemodynamically stable individuals.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Research
Background:
- ST-elevation myocardial infarction (STEMI) treatment aims to restore coronary blood flow.
- Multivessel disease (MVD) complicates STEMI, increasing mortality.
- Complete revascularization (CR) is recommended to reduce major adverse cardiovascular events (MACE).
Purpose of the Study:
- To evaluate the revascularization strategy and its prognostic impact in Portuguese STEMI patients with MVD.
- To compare outcomes between complete and incomplete revascularization in this cohort.
Main Methods:
- Retrospective analysis of 3500 STEMI patients from the Portuguese Registry of Acute Coronary Syndromes (2010-2019).
- Patients categorized by revascularization strategy: complete vs. incomplete.
- Multivariate logistic regression identified predictors of mortality and cardiovascular rehospitalization.
Main Results:
- CR was performed in 21.8% of patients, who were generally younger, healthier, and more hemodynamically stable.
- CR patients had less complex coronary anatomy and fewer chronic occlusions.
- In-hospital and 1-year adverse events were lower in the CR group.
Conclusions:
- Complete revascularization significantly reduces in-hospital and 1-year all-cause mortality and MACE in hemodynamically stable STEMI patients with MVD.
Introduction:
The main treatment for ST-elevation myocardial infarction (STEMI) is the re-establishment of the coronary flow of infarct-related arteries. However, 50% of cases present multivessel disease (MVD), negatively affecting mortality. Complete revascularization (CR) is currently advocated since it reduces major adverse cardiovascular events (MACE).
Objective:
Evaluation of the adopted revascularization strategy and its prognostic value in a Portuguese cohort of STEMI patients with MVD.
Material And Methods:
Retrospective analysis of patients admitted with STEMI included in the Portuguese Registry of Acute Coronary Syndromes between 2010 and 2019. Patients were divided in two groups regarding revascularization strategy (complete versus incomplete) and compared. Independent predictors of a composite of all-cause mortality and rehospitalization for cardiovascular causes were assessed by multivariate logistic regression.
Results:
A total of 3500 patients were included. A CR strategy was performed in 21.8% of patients, who were younger and healthier. They also presented more hemodynamically stable and had less kidney dysfunction and anaemia. Their coronary anatomy was less complex, with a higher prevalence of 2-vessel and a lower proportion of chronic occlusions. In-hospital and 1-year adverse events were less frequent between patients with CR.
Conclusion:
In hemodynamically stable STEMI patients, CR substantially reduced in-hospital and 1-year all-cause mortality and MACE.
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