Key result
Complete revascularization significantly reduced cardiac mortality (p=0.01), repeat MI/ACS (p=0.01), and refractory angina (p=0.038) at 1 year compared to culprit-only PCI in STEMI patients.
Why the study?
Treatment outcomes had not been compared between culprit-vessel-only PCI and complete revascularization following thrombolysis in patients with STEMI and multivessel disease.
Does complete revascularization PCI reduce cardiac mortality, repeat MI/ACS, and refractory angina compared to culprit vessel only PCI in patients with STEMI and multivessel disease following thrombolysis?
RCT (n=108)
randomized into two groups
No
Does complete revascularization PCI reduce cardiac mortality, repeat MI/ACS, and refractory angina compared to culprit vessel only PCI in patients with STEMI and multivessel disease following thrombolysis?
In patients with STEMI and multivessel disease undergoing pharmacoinvasive PCI post-thrombolysis, complete revascularization significantly improves clinical outcomes, including cardiac mortality and repeat MI, compared to culprit-only PCI.
Supports complete revascularization in the pharmacoinvasive setting for STEMI with multiv.
OBJECTIVE: The present study compares the treatment outcomes of only culprit vessel PCI and complete revascularization in patients with STEMI and multivessel disease (MVD) following thrombolysis. METHODS: This was a single-center, prospective randomized study including a total of 108 patients presenting at a tertiary care center within 3-24 h post-thrombolysis and undergoing pharmacoinvasive PCI, and randomized into two groups: complete revascularization PCI group and culprit only PCI group. The primary outcomes were evaluated by cardiac mortality, repeat myocardial infarction (MI)/acute coronary syndrome (ACS) and refractory angina. The secondary outcomes include repeat revascularization and safety outcomes namely contrast induced nephropathy (CIN), cerebrovascular accident (CVA) and major bleeding were compared among both the groups at one year follow-up. RESULTS: Complete revascularization PCI group and culprit only PCI group had 54 patients in each group. Left ventricular ejection fraction did not show significant difference at discharge (p = 1) but was significantly improved in complete revascularization PCI group (p = 0.001) at one year follow-up. Reduced number of outcomes with a significant difference in both the groups were seen for primary outcomes such as cardiac mortality (p = 0.01), repeat MI/ACS (p = 0.01) and refractory angina (p = 0.038) along with repeat revascularization (p = 0.001) at one year follow-up. Complete revascularization did not show any statistically significant difference for CIN (p = 0.567), CVA (p = 0.153) and major bleeding (p = 0.322) then culprit only revascularization group. CONCLUSION: In patients with STEMI and MVD, complete revascularization was found more favourable in terms of primary and secondary outcomes compared to culprit only revascularization.
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Jain et al. (2023) conducted an RCT in ST elevation myocardial infarction and multivessel coronary artery disease (n=108). Complete revascularization PCI vs. Culprit only PCI was evaluated on Cardiac mortality, repeat myocardial infarction (MI)/acute coronary syndrome (ACS) and refractory angina (p=0.01 for cardiac mortality, 0.01 for repeat MI/ACS, 0.038 for refractory angina). Complete revascularization significantly reduced cardiac mortality (p=0.01), repeat MI/ACS (p=0.01), and refractory angina (p=0.038) at 1 year compared to culprit-only PCI in STEMI patients.
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