Key result
A staged PCI strategy for angiographically significant non-culprit lesions was associated with a significantly lower 5-year mortality compared with a culprit-only PCI strategy (adjusted HR 0.69).
Why the study?
Does staged PCI for non-culprit lesions reduce all-cause death compared to culprit-only PCI in STEMI patients with multivessel disease?
Observational (n=1,311)
Yes
Does staged PCI for non-culprit lesions reduce all-cause death compared to culprit-only PCI in STEMI patients with multivessel disease?
Hazard Ratio: 0.69 (95% CI 0.5–0.96)
Absolute Event Rate: 9.5% vs 16%
p-value: p=0.03
In STEMI patients with multivessel disease, a staged PCI strategy for non-culprit lesions within 90 days is associated with lower 5-year mortality compared to culprit-only PCI.
Supports staged PCI evaluation in STEMI multivessel disease; leaves open randomized confirmation of mortality benefit.
BACKGROUND: We assessed the current status of treatment strategy in ST-segment elevation myocardial infarction (STEMI) with multivessel disease (MVD) in real world practice, focusing on the benefit of staged percutaneous coronary intervention (PCI). METHODS AND RESULTS: From the CREDO-Kyoto AMI Registry, 2,010 STEMI patients with MVD undergoing primary PCI were analyzed. Only 96 patients (4.8%) received acute multivessel PCI, and the majority of patients (n=1,914, 95.2%) had culprit-only PCI acutely. After excluding 699 patients (acute multivessel PCI, Killip class ≥3, age ≥90 years, coronary artery bypass grafting within 90 days, or clinical events within 90 days), 681 MVD patients underwent staged PCI for angiographically significant non-culprit lesions within 90 days (staged PCI group), while 630 MVD patients received primary PCI only (culprit-only PCI group). The cumulative 5-year incidence of and adjusted risk for all-cause death were significantly lower in the staged PCI group compared with the culprit-only PCI group (9.5% vs. 16.0%, P<0.001; HR, 0.69; 95% CI: 0.50-0.96, P=0.03). The risks for MI and any coronary revascularization favored the staged PCI strategy. CONCLUSIONS: The staged PCI strategy for angiographically significant non-culprit lesions was associated with lower 5-year mortality compared with the culprit-only PCI strategy in STEMI patients with MVD who underwent primary PCI.
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Toyota et al. (2015) conducted an observational in ST-segment elevation myocardial infarction (STEMI) with multivessel disease (n=1,311). Staged percutaneous coronary intervention (PCI) for non-culprit lesions vs. Culprit-only PCI strategy was evaluated on All-cause death (HR 0.69, 95% CI 0.50-0.96, p=0.03). A staged PCI strategy for angiographically significant non-culprit lesions was associated with a significantly lower 5-year mortality compared with a culprit-only PCI strategy (adjusted HR 0.69).
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