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Complete versus culprit only revascularization in young STEMI patients with multivessel disease
1Department of Cardiology, Haseki Training and Research Hospital, Istanbul, Turkiye.
Insights
Complete revascularization in young ST-elevation myocardial infarction (STEMI) patients with multivessel disease significantly lowers major adverse cardiovascular events (MACE). This strategy is superior to culprit-only percutaneous coronary intervention (PCI), improving survival outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes
Background:
- Uncertainties exist regarding optimal revascularization strategies for younger patients experiencing ST-segment elevation myocardial infarction (STEMI).
- Limited data specifically addresses the benefits of complete revascularization versus culprit-only percutaneous coronary intervention (PCI) in this demographic.
Purpose of the Study:
- To compare the efficacy of complete revascularization against culprit-only PCI in reducing major adverse cardiovascular events (MACE) and all-cause mortality.
- To investigate the impact of revascularization strategies on STEMI patients with multivessel disease.
Main Methods:
- A retrospective cohort study involving 431 STEMI patients treated between January 2022 and December 2023.
- Patients were divided into two groups: culprit-only PCI (n=219) and complete revascularization (n=212).
- Data collected included demographics, procedural details, medications, laboratory results, and echocardiography, with MACE and all-cause mortality as primary and secondary endpoints.
Main Results:
- Complete revascularization was associated with a 61% reduction in MACE risk (p < 0.001) and fewer urgent CABG requirements (p = 0.020).
- Higher MACE incidence was observed in the culprit-only PCI group (p < 0.001).
- Elevated postoperative creatinine and reduced left ventricular ejection fraction independently predicted adverse outcomes, while beta-blocker and antilipemic therapy use correlated with improved survival.
Conclusions:
- Complete revascularization significantly reduces MACE in young STEMI patients with multivessel disease compared to culprit-only PCI.
- Renal dysfunction and impaired left ventricular ejection fraction are independent predictors of adverse outcomes.
- Beta-blocker and antilipemic therapies are associated with improved survival in this patient population.
Introduction:
There are still uncertainties regarding revascularization strategies in younger ST segment elevation myocardial infarction (STEMI) patients, largely due to limited data in this specific population.
Aim:
To determine whether complete revascularization reduces major adverse cardiovascular events (MACEs) and all cause mortality compared to culprit only percutaneous coronary intervention (PCI) in cases of STEMI among patients with multivessel disease.
Material And Methods:
In this single center retrospective cohort study, we examined 431 STEMI patients treated between January 2022 and December 2023. Among these, 219 had undergone culprit only while 212 had received complete revascularization. Baseline demographics, angiographic and procedural variables, pharmacotherapy, laboratory, and echocardiographic data were collected. The primary endpoint was incidence of MACE, and the secondary endpoint was all cause mortality. Independent predictors of MACE and death were determined.
Results:
The median age was 49 years (IQR 46-50), and 89.1% were male. MACE occurred in 135 (31.3%) patients, with higher incidence in the culprit only group (p < 0.001). Complete revascularization was associated with a 61% reduction in MACE risk (p < 0.001) and significantly lower urgent CABG requirements (p = 0.020). Elevated postoperative creatinine (p < 0.001 for MACE; p = 0.002 for mortality) and reduced postoperative left ventricular ejection fraction (p < 0.001 for MACE; p < 0.001 for mortality) were independent adverse predictors. b-blocker use (p = 0.028), antilipemic therapy (p < 0.001), and a history of hyperlipidemia (p < 0.001) were independently associated with reduced mortality.
Conclusions:
In young STEMI patients with multivessel disease, complete revascularization significantly reduces MACE compared to culprit-only PCI. Renal dysfunction and impaired left ventricular ejection fraction independently predict adverse outcomes, while b-blocker and antilipemic therapy are associated with improved survival.
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