In-hospital versus after-discharge complete revascularization in patients with ST segment elevation myocardial...

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.