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Complete revascularization with PCI in STEMI patients with multivessel disease, when is the appropriate time?
Heberto Aquino-Bruno1, Juan F García-García1, Roberto Muratalla-González1
1Department of Cardiology, Centro Médico Nacional 20 de Noviembre, ISSSTE, Mexico City, Mexico.
Insights
One-time multivessel revascularization (OTMVR) showed better clinical outcomes and fewer complications than staged revascularization for ST-elevation myocardial infarction patients with multivessel coronary artery disease.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- ST-elevation myocardial infarction (STEMI) with multivessel coronary artery disease (CAD) presents complex treatment decisions.
- Revascularization strategies aim to improve outcomes but require careful consideration of timing and approach.
Purpose of the Study:
- To compare clinical outcomes between one-time multivessel revascularization (OTMVR) and in-hospital staged complete revascularization in STEMI patients with multivessel CAD.
- To identify risk factors associated with mortality in this patient population.
Main Methods:
- Retrospective, observational cohort study of 634 STEMI patients with multivessel CAD (January 2013 - April 2019).
- Comparison of outcomes between OTMVR (n=306) and staged revascularization (n=328).
- Primary endpoint: in-hospital mortality; Secondary endpoints: cardiovascular complications, 30-day and 1-year mortality/hospitalization.
Main Results:
- The OTMVR group had less complex coronary lesions and a higher proportion of left anterior descending artery culprit lesions.
- OTMVR was associated with a lower incidence of primary and secondary endpoints compared to staged revascularization.
- No significant increase in complications was observed with the OTMVR strategy.
Conclusions:
- One-time multivessel revascularization is a safe and effective strategy for STEMI patients with multivessel CAD.
- OTMVR demonstrated superior clinical outcomes, including reduced mortality and complications, compared to staged revascularization.
- This approach may be preferred in selected STEMI patients with multivessel disease.
Objective:
The purpose was to compare the outcomes of patients with ST-elevation myocardial infarction and multivessel coronary artery disease undergoing one-time multivessel revascularization (OTMVR) versus in-hospital staged complete revascularization with percutaneous coronary intervention.
Methods:
This was a single-center, retrospective, observational, and cohort study, including data from January 2013 to April 2019. A total of 634 patients were included in the study. Comparisons were made between patients who underwent in-hospital staged complete revascularization versus OTMVR. The primary endpoint was all-cause in-hospital mortality, secondary endpoints included cardiovascular complications, all-cause new hospitalization, and mortality evaluated at 30 days and 1 year. In addition, we constructed a logistic regression model for determining the risk factors that predicted mortality.
Results:
Of the 634 patients, 328 were treated with staged revascularization and 306 with OTMVR. About 76.7% were men, with a mean age of 63.3 years. Less complex coronary lesions and a higher proportion of the left anterior descending artery as the culprit vessel were found in the OTMVR group. Compared with staged revascularization, the primary and secondary endpoints occurred less frequently with OTMVR strategy.
Conclusions:
OTMVR did not generate more complications and demonstrate better clinical outcomes than in-hospital staged revascularization.
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