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Immediate versus staged complete revascularisation in patients presenting with STEMI and multivessel disease

Paola Scarparo1, Jacob J Elscot1, Hala Kakar1

  • 1Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands.

Eurointervention : Journal of Europcr in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
|July 15, 2024
PubMed

Insights

Immediate complete revascularisation (ICR) and staged complete revascularisation (SCR) showed similar 1-year clinical outcomes for ST-elevation myocardial infarction (STEMI) patients. While ICR trended towards better outcomes at 30 days, both strategies proved comparable in the long term.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Clinical Trials

Background:

  • Complete revascularisation is recommended for ST-elevation myocardial infarction (STEMI) with multivessel disease (MVD).
  • The optimal timing for revascularising non-culprit lesions remains a subject of debate.
  • Previous trials support complete revascularisation in STEMI patients without cardiogenic shock.

Purpose of the Study:

  • To compare immediate complete revascularisation (ICR) versus staged complete revascularisation (SCR) in STEMI patients with MVD.
  • To evaluate the impact of ICR versus SCR on key clinical outcomes at one year.
  • To analyze secondary endpoints including mortality, myocardial infarction, and cerebrovascular events.

Main Methods:

  • A prespecified analysis of the BioVasc trial was conducted.
  • STEMI patients with MVD were randomized to either ICR or SCR groups.
  • The primary endpoint was a composite of all-cause mortality, myocardial infarction, unplanned revascularisation, or cerebrovascular events at 1-year follow-up.

Main Results:

  • No significant difference in the primary endpoint was observed between ICR and SCR groups at 1 year (7.0% vs 8.3%, HR 0.84, p=0.55).
  • Individual components of the primary endpoint, including mortality, myocardial infarction, and cerebrovascular events, did not differ significantly between the groups.
  • A trend towards a reduction in the primary endpoint was noted at 30 days favoring ICR (3.0% vs 6.0%, HR 0.50, p=0.09).
  • ICR was associated with a significantly shorter hospital stay (median 3 days vs 4 days, p<0.001).

Conclusions:

  • One-year clinical outcomes were similar for STEMI patients undergoing immediate versus staged complete revascularisation.
  • While immediate revascularisation may offer early benefits and reduce hospital stay, long-term results are comparable to staged procedures.
  • The findings contribute to the ongoing discussion regarding the optimal timing of complete revascularisation in STEMI patients with MVD.
Abstract

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