Key result
Staged percutaneous coronary intervention performed within one week after primary PCI significantly reduced the risk of major adverse cardiovascular events (HR 0.40) compared to a strategy of 2-12 weeks in patients with STEMI and multivessel disease.
Why the study?
Does staged PCI within 2 weeks reduce MACE in STEMI patients with multivessel disease compared to staged PCI at 2-12 weeks?
Cohort (n=428)
No
Does staged PCI within 2 weeks reduce MACE in STEMI patients with multivessel disease compared to staged PCI at 2-12 weeks?
Effect estimate: HR 0.40 (95% CI 0.24-0.65)
Absolute Event Rate: 23% vs 40%
p-value: p=0.001
Staged PCI for non-culprit vessels within two weeks of primary PCI is associated with a lower risk of MACE compared to later staged PCI (2-12 weeks) in STEMI patients with multivessel disease.
May support staged PCI within 1 week in STEMI multivessel disease; leaves open optimal timing pending randomized confirmation.
BACKGROUND: Studies have shown that staged percutaneous coronary intervention (PCI) for non-culprit lesions is beneficial for prognosis of ST-segment elevation myocardial infarction (STEMI) patients with multivessel disease. However, the optimal timing of staged revascularization is still controversial. This study aimed to find the optimal timing of staged revascularization. METHODS: A total of 428 STEMI patients with multivessel disease who underwent primary PCI and staged PCI were included. According to the time interval between primary and staged PCI, patients were divided into three groups (≤ 1 week, 1-2 weeks, and 2-12 weeks after primary PCI). The primary endpoint was major adverse cardiovascular events (MACE), a composite of all-cause death, non-fatal re-infarction, repeat revascularization, and stroke. Cox regression model was used to assess the association between staged PCI timing and risk of MACE. RESULTS: = 0.001). In the multivariable adjustment model, the timing interval of staged PCI ≤ 1 week and 1-2 weeks were both significantly associated with a lower risk of MACE [hazard ratio (HR): 0.40, 95% confidence intervals (CI): 0.24-0.65; HR: 0.54, 95% CI: 0.31-0.93, respectively], mainly attributed to a lower risk of repeat revascularization (HR: 0.41, 95% CI: 0.24-0.70; HR: 0.36, 95% CI: 0.18-0.7), compared with a strategy of 2-12 weeks later of primary PCI. CONCLUSIONS: The optimal timing of staged PCI for non-culprit vessels should be within two weeks after primary PCI for STEMI patients.
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Zhao et al. (2018) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) with multivessel disease (n=428). Staged PCI ≤ 1 week after primary PCI vs. Staged PCI 2-12 weeks after primary PCI was evaluated on Major adverse cardiovascular events (MACE), a composite of all-cause death, non-fatal re-infarction, repeat revascularization, and stroke (HR 0.40, 95% CI 0.24-0.65, p=0.001). Staged percutaneous coronary intervention performed within one week after primary PCI significantly reduced the risk of major adverse cardiovascular events (HR 0.40) compared to a strategy of 2-12 weeks in patients with STEMI and multivessel disease.
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