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

Felix Lindberg1, Brynjölfur Mogensen2, Sergio Buccheri3

  • 1Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.

JACC. Cardiovascular Interventions
|May 28, 2025
PubMed

Insights

Complete revascularization (CR) increased in ST-elevation myocardial infarction (STEMI) patients with multivessel disease (MVD). Both angiographic and physiology-guided CR were linked to better outcomes, including reduced mortality.

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.
Abstract

Keywords:
STEMIcomplete revascularizationfractional flow reservemultivessel disease

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