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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Immediate versus staged complete revascularization in patients with ST-segment elevation myocardial infarction and
Soohyung Park1, Seung-Woon Rha2, Byoung Geol Choi3
1Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea.
Insights
This study compared immediate versus staged complete revascularization in ST-segment elevation myocardial infarction (STEMI) with multivessel disease (MVD). Staged revascularization showed a trend toward fewer major adverse cardiovascular events (MACE) but requires further research.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Trials
Background:
- ST-segment elevation myocardial infarction (STEMI) with multivessel disease (MVD) presents complex treatment challenges.
- Complete revascularization is a key goal in managing STEMI and MVD.
- The optimal timing for complete revascularization remains an area of investigation.
Purpose of the Study:
- To compare clinical outcomes between immediate and staged complete revascularization strategies.
- To evaluate the safety and efficacy of different revascularization timings in STEMI patients with MVD.
- To assess major adverse cardiovascular events (MACE) and other endpoints at 12 months.
Main Methods:
- A prospective, randomized, multicenter registry of 248 patients with STEMI and MVD.
- Immediate revascularization: one-time percutaneous coronary intervention (PCI) of culprit and non-culprit lesions.
- Staged revascularization: PCI of non-culprit lesions at a later date (mean 4.4 days).
Main Results:
- Major adverse cardiovascular events (MACE) occurred in 11.6% of the immediate group vs. 7.5% in the staged group (HR 1.60, 95% CI 0.65-3.91).
- Total death was numerically higher in the immediate group (9.7% vs. 2.8%).
- No significant differences were observed in other MACE components, cardiac death, stroke, or in-hospital complications.
Conclusions:
- The study was underpowered to draw definitive conclusions on the optimal complete revascularization strategy for STEMI and MVD.
- A trend towards fewer MACE with staged revascularization was observed.
- Larger randomized trials are needed to confirm the optimal timing of complete revascularization.
Background:
We aimed to compare clinical outcomes between immediate and staged complete revascularization in primary percutaneous coronary intervention (PCI) for treating ST-segment elevation myocardial infarction (STEMI) and multivessel disease (MVD).
Methods:
A total of 248 patients were enrolled in a prospective, randomized, and multicenter registry. Immediate revascularization was defined as one-time PCI of culprit and non-culprit lesions at the initial procedure. Staged revascularization was defined as PCI of non-culprit lesions at a later date (mean, 4.4 days; interquartile range, 1-11.4), following initial culprit revascularization. The end points were major adverse cardiovascular events (MACE; composite of total death, recurrent myocardial infarction, and revascularization), any individual components of MACE, cardiac death, stent thrombosis, and stroke at 12 months.
Results:
During a follow-up of 1 year, MACE occurred in 12 patients (11.6%) in the immediate revascularization group and in 8 patients (7.5%) in staged revascularization group (hazard ratio [HR] 1.60, 95% confidence interval [CI] 0.65-3.91). The incidence of total death was numerically higher in the immediate group than in the staged group (9.7% vs 2.8%, HR 3.53, 95% CI 0.97-12.84); There were no significant differences between the 2 groups in risks of any individual component of MACE, cardiac death, stroke, and in-hospital complications, such as need for transfusion, bleeding, acute renal failure, and acute heart failure. This study was prematurely terminated due to halt of production of everolimus-eluting stents (manufactured as PROMUS Element by Boston Scientific, Natick, Massachusetts).
Conclusions:
Due to its limited power, no definite conclusion can be drawn regarding complete revascularization strategy from the present study. Further large randomized clinical trials would be warranted to confirm optimal timing of complete revascularization for patients with STEMI and MVD.
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