Key result
In-hospital staged complete revascularization was associated with a reduced risk of MACCE compared to culprit-only PCI in patients with STEMI and multivessel disease (HR 0.48; 95% CI 0.29-0.82).
Why the study?
The long-term relative benefit of culprit-only PCI versus staged PCI in patients with STEMI and multivessel disease remained disputable.
Does in-hospital staged complete revascularization reduce MACCE in patients with STEMI and multivessel disease compared to culprit-only PCI?
Cohort (n=452)
No
Does in-hospital staged complete revascularization reduce MACCE in patients with STEMI and multivessel disease compared to culprit-only PCI?
Hazard Ratio: 0.48 (95% CI 0.29–0.82)
In patients with STEMI and multivessel disease, an in-hospital staged complete revascularization strategy is associated with significantly lower long-term MACCE compared to culprit-only PCI.
Supports staged complete revascularization for lower MACCE in STEMI with multivessel disease; leaves open need for randomized confirmation.
BACKGROUND: The long-term relative benefit of culprit-only percutaneous coronary intervention (PCI) and staged PCI in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease remains disputable. This study aimed to compare the long-term outcomes of culprit-only PCI and in-hospital staged complete revascularization in real-world patients with STEMI and multivessel coronary artery disease. PATIENTS AND METHODS: A total of 452 patients were treated with in-hospital staged complete revascularization (n=133) or culprit-only PCI (n=319) between May 2012 and December 2015 in our center. The primary end point was major adverse cardiac and cerebrovascular event (MACCE), defined as a composite of all-cause death, nonfatal myocardial infarction, stroke, and unplanned revascularization. RESULTS: The median follow-up period was 3.2 years. Overall, treatment with in-hospital staged complete revascularization can reduce the incidence of the primary end point of MACCE in both the overall population [hazard ratio (HR): 0.48; 95% confidence interval (CI): 0.29-0.82] and the propensity-matched cohorts (HR: 0.51; 95% CI: 0.27-0.97). After correction of the possible confounders, staged PCI remained associated with decreased risk of MACCE (HR: 0.56; 95% CI: 0.33-0.96). Besides, the strategy of staged PCI tended to be associated with lower risk of a composite of cardiac death, myocardial infarction, and stroke than culprit-only PCI in multivariable-adjusted analysis (HR: 0.30; 95% CI: 0.09-1.01). CONCLUSION: In patients with STEMI and multivessel disease undergoing primary PCI, an approach of in-hospital staged complete revascularization was associated with a better 3-year composite outcome compared with culprit-only PCI.
No takes yet. Share an insight, caveat, or question.
Cui et al. (2019) conducted a cohort in ST-segment elevation myocardial infarction and multivessel disease (n=452). In-hospital staged complete revascularization vs. Culprit-only PCI was evaluated on Major adverse cardiac and cerebrovascular event (MACCE), defined as a composite of all-cause death, nonfatal myocardial infarction, stroke, and unplanned revascularization (HR 0.48, 95% CI 0.29-0.82). In-hospital staged complete revascularization was associated with a reduced risk of MACCE compared to culprit-only PCI in patients with STEMI and multivessel disease (HR 0.48; 95% CI 0.29-0.82).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: