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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
In-hospital versus after-discharge complete revascularization in patients with ST segment elevation myocardial
Eva Rumiz1,2,3, Ernesto Valero2,4,5, Carmen Fernandez1
1Cardiology Department, Consorcio Hospital General Universitario, Valencia, Spain.
Insights
Delaying nonculprit-lesion revascularization after discharge for ST-segment elevation myocardial infarction (STEMI) patients with multivessel disease (MVD) significantly shortens hospital stays. This strategy does not increase major adverse cardiovascular events (MACE) within 12 months.
Area of Science:
- Cardiology
- Interventional Cardiology
- Health Services Research
Background:
- Complete revascularization (CR) in ST-segment elevation myocardial infarction (STEMI) with multivessel disease (MVD) reduces major adverse cardiovascular events (MACE).
- Uncertainty exists regarding the optimal timing of nonculprit-lesion revascularization (in-hospital vs. delayed) and its impact on healthcare resource utilization.
- This study addresses the impact of in-hospital versus delayed nonculprit-lesion revascularization on index hospitalization length.
Purpose of the Study:
- To evaluate the impact of in-hospital versus delayed nonculprit-lesion revascularization on the length of index hospitalization in STEMI patients with MVD.
- To compare the rates of major adverse cardiovascular events (MACE) between the two strategies at 12-month follow-up.
Main Methods:
- A single-center randomized study assigned STEMI patients with MVD and successful culprit-lesion PCI to either in-hospital CR or delayed CR after discharge.
- The primary endpoint was the length of hospital stay.
- The secondary endpoint was the composite of cardiovascular death, myocardial infarction, or ischemia-driven revascularization at 12 months.
Main Results:
- A total of 258 patients were enrolled (131 in-hospital CR, 127 delayed CR).
- The delayed CR strategy significantly reduced the length of hospital stay (4 days vs. 7 days; p=0.001).
- No significant difference in MACE was observed at 12 months between the in-hospital CR and delayed CR groups (5.34% vs. 3.15%; p=0.397).
Conclusions:
- In STEMI patients with MVD, a delayed CR strategy after discharge reduces index hospitalization length.
- This approach does not increase the risk of MACE at 12 months compared to in-hospital CR.
- Delayed nonculprit-lesion revascularization is a safe and resource-efficient strategy for selected STEMI patients.
Introduction:
Complete revascularization (CR) in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease (MVD), is associated with a reduction in major adverse cardiovascular events (MACE). However, there is uncertainty about whether nonculprit-lesion revascularization should be performed, during index hospitalization or delayed, especially regarding health care resources utilization. In this study, we aimed to evaluate the impact of in-hospital nonculprit-lesion revascularization vs. delayed (after discharge) revascularization on the length of index hospitalization.
Methods:
In this single-center study, we randomly assigned patients with STEMI and MVD who underwent successful culprit-lesion PCI to a strategy of either CR during in-hospital admission or a delayed CR after discharge. The first primary endpoint was the length of hospital stay. The second endpoint was the composite of cardiovascular death, myocardial infarction or ischemia-driven revascularization at 12 months (MACE).
Results:
From January 2018 to December 2022, we enrolled 258 patients (131 allocated to CR during in-hospital admission and 127 to an after-discharge CR). We found a significant reduction in the length of hospital stay in those assigned to after-discharge CR strategy [4 days (3-5) versus 7 days (5-9); p = 0.001]. At 12-month of follow-up, no differences were found in the occurrence of MACE, 7 (5.34%) patients in in-hospital CR and 4 (3.15%) in after-discharge CR strategy; (hazard ratio, 0.59; 95% confidence interval, 0.17 to 2.02; p = 0.397).
Conclusions:
In STEMI patients with MVD, an after-discharge CR strategy reduces the length of index hospitalization without an increased risk of MACE after 12 months of follow-up.
Trial Registration:
ClinicalTrials.gov number: NCT04743154.
