Key result
Immediate multivessel intervention did not significantly reduce 1-year major adverse cardiac events compared with culprit-vessel intervention only (7.7% vs 8.9%; HR 0.86; 95% CI 0.50-1.47).
Why the study?
The safety and efficacy of immediate multivessel coronary intervention remain controversial in patients with STEMI and multivessel disease.
Does immediate multivessel intervention reduce 1-year major adverse cardiac events in stable STEMI patients with multivessel disease compared to culprit-vessel intervention only?
Cohort (n=1,191)
Yes
Does immediate multivessel intervention reduce 1-year major adverse cardiac events in stable STEMI patients with multivessel disease compared to culprit-vessel intervention only?
In stable STEMI patients with multivessel disease, immediate multivessel intervention did not improve 1-year composite clinical outcomes compared to culprit-lesion only intervention, though it reduced the need for repeat revascularization.
May not support immediate multivessel PCI in stable STEMI; leaves open need for RCTs to guide complete revascularization.
BACKGROUND: The safety and efficacy of immediate multivessel coronary intervention (MVI) remain controversial in patients with ST-elevation myocardial infarction (STEMI) and multivessel disease (MVD). This study aimed to investigate the clinical outcomes of immediate MVI compared with culprit-vessel intervention only (CVI-O) in diverse subgroups with STEMI and MVD. PATIENTS AND METHODS: We compared immediate MVI (n=260) and CVI-O (n=931) regarding 1-year major adverse cardiac event rates for cardiac death, recurrent myocardial infarction (MI), and repeat revascularization in 1191 STEMI patients with MVD using data from the Korea Acute Myocardial Infarction-National Institutes of Health registry (2011-2015). High-risk patients and those who underwent a staged procedure were excluded from the analysis. Furthermore, propensity score matching and stratified subgroup analyses were performed. RESULTS: Immediate MVI and CVI-O groups had similar 1-year major adverse cardiac event rates [7.7 vs. 8.9%, hazard ratio (HR): 0.86, 95% confidence interval (CI): 0.50-1.47, log-rank P=0.5628]. No difference was found between the groups in terms of the 1-year rate of cardiac death (2.9 vs. 1.3%, HR: 2.24, 95% CI: 0.75-6.67) or recurrent MI (2 vs. 1.5%, HR: 1.41, 95% CI: 0.45-4.44). However, repeat revascularization occurred less frequently in the immediate MVI group than in the CVI-O group (2.0 vs. 5.7%, HR: 0.35, 95% CI: 0.13-0.90, log-rank P=0.0142). These findings were found to be consistent across a broad spectrum of subgroups. CONCLUSION: Compared with CVI-O, immediate MVI did not improve 1-year net clinical outcomes in stable STEMI patients with MVD. The only benefit found was a reduced repeat revascularization in immediate MVI.
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Ahn et al. (2018) conducted a cohort in ST-elevation myocardial infarction and multivessel coronary disease (n=1,191). Immediate multivessel coronary intervention vs. Culprit-vessel intervention only was evaluated on 1-year major adverse cardiac event rates for cardiac death, recurrent myocardial infarction, and repeat revascularization (HR 0.86, 95% CI 0.50-1.47, p=0.5628). Immediate multivessel intervention did not significantly reduce 1-year major adverse cardiac events compared with culprit-vessel intervention only (7.7% vs 8.9%; HR 0.86; 95% CI 0.50-1.47).
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