Comparison of Multivessel Versus Culprit-Vessel-Only Revascularization in Patients With STEMI and Multivessel Disease
Tinghao Zhao1,2, Jun Wang1,2, Ruoxi Gu1
1National Key Laboratory of Frigid Zone Cardiovascular Disease, Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, Liaoning, China.
Insights
Complete revascularization in STEMI patients with multivessel disease undergoing primary PCI did not improve in-hospital outcomes. Multivessel PCI was linked to higher adverse events, including mortality and kidney injury, compared to culprit-vessel-only PCI in a Chinese population.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Research
Background:
- The benefit of complete revascularization in ST-segment elevation myocardial infarction (STEMI) patients with multivessel coronary artery disease (MVD) during primary percutaneous coronary intervention (PCI) remains debated.
- Current guidelines do not offer a definitive consensus on the optimal revascularization strategy for these complex patients.
Purpose of the Study:
- To evaluate the impact of multivessel PCI (MV-PCI) versus culprit-vessel-only PCI (CV-PCI) on in-hospital outcomes.
- To assess the safety and efficacy of complete revascularization in a Chinese STEMI population with MVD.
Main Methods:
- Retrospective analysis of STEMI patients with MVD undergoing PCI from the CCC-ACS project (November 2014–December 2019).
- Utilized inverse probability of treatment weighting (IPTW) and multivariable Cox regression to compare outcomes between MV-PCI and CV-PCI groups.
- Primary endpoint was in-hospital Major Adverse Cardiac Events (MACE); secondary endpoints included all-cause mortality and contrast-induced acute kidney injury (CI-AKI).
Main Results:
- Out of 8138 patients, 840 (10.3%) underwent MV-PCI and 7298 (89.7%) underwent CV-PCI.
- MV-PCI was associated with significantly higher in-hospital MACE (2.0% vs. 0.9%, p=0.005), all-cause mortality (1.7% vs. 0.7%, p=0.003), and CI-AKI (13.6% vs. 10.2%, p=0.002) after IPTW adjustment.
- Multivariable Cox analysis confirmed the increased risks associated with MV-PCI.
Conclusions:
- In the Chinese STEMI population with MVD, MV-PCI during primary PCI was linked to increased in-hospital adverse events compared to CV-PCI.
- Findings suggest a cautious approach to MV-PCI in this setting.
- A staged PCI strategy for nonculprit vessels may be preferred in this patient cohort.
Background:
The consensus on whether acute ST-segment elevation myocardial infarction (STEMI) patients with multivessel coronary artery disease (MVD) benefit from complete revascularization during primary percutaneous coronary intervention (PCI) is unclear.
Aims:
This study aims to assess the impact of multivessel PCI (MV-PCI) versus culprit-vessel-only PCI (CV-PCI) on in-hospital outcomes in a Chinese population.
Methods:
We evaluated STEMI patients with MVD undergoing PCI, registered in the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome (CCC-ACS) project, from November 2014 to December 2019. Using inverse probability of treatment weighting (IPTW) and multivariable Cox regression, we compared the incidence of in-hospital Major Adverse Cardiac Events (MACE) and other adverse clinical outcomes between the MV-PCI and CV-PCI groups.
Results:
Among 8138 patients included, 840 (10.3%) underwent MV-PCI, and 7298 (89.7%) underwent CV-PCI. MV-PCI was associated with higher in-hospital MACE (2.0% vs. 0.9%, p = 0.005), all-cause mortality (1.7% vs. 0.7%, p = 0.003), and contrast-induced acute kidney injury (CI-AKI) (13.6% vs. 10.2%, p = 0.002), after IPTW adjustment. The multivariable Cox analysis further validated the increased risks associated with MV-PCI.
Conclusion:
In the Chinese STEMI population with MVD, participating in the CCC-ACS project, MV-PCI during primary PCI was linked to higher in-hospital adverse events compared to CV-PCI. These findings advocate for a cautious approach to MV-PCI in this setting, suggesting a potential preference for a staged PCI strategy for nonculprit vessels.
Trial Registration:
The information of clinical trial registration for CCC-ACS project can be found at http://clinicaltrials.gov/study/NCT02306616.
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