Revascularization Strategies in ST-Segment Elevation Myocardial Infarction With Multivessel Disease: Temporal Trends,...

Area of Science:

• Cardiology
• Interventional Cardiology
• Clinical Outcomes Research

Background:

• Randomized trials support complete revascularization (CR) over incomplete revascularization (IR) for ST-segment elevation myocardial infarction (STEMI) with multivessel disease (MVD).
• The clinical practice implementation of CR strategies remains uncertain.

Purpose of the Study:

• To assess temporal trends in revascularization strategies for STEMI patients with MVD undergoing percutaneous coronary intervention.
• To evaluate the association of different revascularization strategies with patient outcomes.

Main Methods:

• Analysis of 20,131 patients from the SWEDEHEART registry undergoing primary percutaneous coronary intervention for STEMI with MVD (2009-2021).
• Primary outcome: composite of all-cause mortality, myocardial infarction, or unplanned revascularization, landmarked at 90 days.
• Compared outcomes for angiographic CR, physiology-guided CR, and incomplete revascularization (IR).

Main Results:

• Adoption of CR increased from 33% in 2009 to 51% in 2021; physiology-guided CR rose from 0% to 14%.
• Adjusted analysis showed lower risk of primary events with angiographic CR vs. IR (aHR: 0.84) and physiology-guided CR vs. IR (aHR: 0.80).
• No significant difference in outcomes between physiology-guided CR and angiographic CR was observed (aHR: 0.94).

Conclusions:

• CR, including physiology-guided procedures, has seen increased implementation in STEMI patients with MVD.
• Both angiographic and physiology-guided CR are independently associated with favorable clinical outcomes.
• These findings support the broader adoption of CR strategies in clinical practice.