Clinical outcomes of complete revascularization in acute myocardial infarction patients with high bleeding risk and multivessel disease

Abstract Background High bleeding risk (HBR) is associated with an increased risk of both ischemic and bleeding events and is known to have a worse prognosis than those with non-HBR in patients with acute myocardial infarction (AMI). However, data regarding the prognostic impact of complete revascularization (CR) in AMI and multivessel disease patients complicated by HBR remain limited. Purpose We sought to evaluate the clinical implications of CR in patients with AMI and multivessel disease, stratified by HBR status through a large-scaled, nationwide, multicenter, prospective registry. Methods A total of 13,460 patients with AMI and multivessel disease who underwent successful percutaneous coronary intervention (PCI) for infarct-related artery (IRA) were selected from the patient-level pooled data of a nationwide Korean registry from 2011 to 2020. Primary outcome was major adverse cardiac and cerebrovascular event (MACCE), a composite of all-cause death, MI, repeat revascularization, stent thrombosis, and cerebrovascular event during 3 years of follow-up. Results Of the 13,460 patients, 4,401 (32.7%) were classified as the HBR group. Both HBR and non-HBR groups were further subdivided based on whether complete revascularization (CR) was performed for non-IRA. Patients who underwent CR were associated with lower risk of MACCE at 3 years than those with incomplete revascularization (IR) in both HBR (IR vs. CR, 40.0% vs. 28.1%, adjusted HR 0.67, 95% CI 0.59-0.75, P 0.001) and non-HBR groups (19.0% vs. 13.1%, adjusted HR 0.70, 95% CI 0.62-0.78, P 0.001) (P for interaction=0.822). The incidence of bleeding events was similar between the CR and IR groups in both HBR (10.7% vs. 10.0%, adjusted HR 1.10, 95% CI 0.88-1.38, P=0.408) and non-HBR groups (4.2% vs. 5.0%, adjusted HR 1.21, 95% CI 0.97-1.50, P=0.090) (P for interaction=0.310). Conclusion In patients with AMI and multivessel disease, CR was associated with a lower risk of MACCE compared to IR in both HBR and non-HBR groups, without a significant difference in bleeding risk.