Key result
In-hospital multivessel PCI was associated with a lower risk of 30-day MACCE than culprit-only PCI in patients with STEMI and multivessel disease (adjusted OR 0.75; 95% CI 0.57-0.98; P=0.032).
Why the study?
Data demonstrating the benefit of multivessel PCI over culprit-only intervention in STEMI with multivessel disease were limited to small single-center Chinese cohorts.
Does in-hospital multivessel PCI reduce 30-day MACCE in patients with STEMI and multivessel coronary artery disease compared to culprit-only PCI?
Cohort (n=5,935)
Yes
Does in-hospital multivessel PCI reduce 30-day MACCE in patients with STEMI and multivessel coronary artery disease compared to culprit-only PCI?
Odds Ratio: 0.75 (95% CI 0.57–0.98)
p-value: p=0.032
In-hospital multivessel PCI is associated with a reduced risk of 30-day MACCE compared to culprit-only PCI in patients with STEMI and multivessel disease.
May support multivessel PCI in STEMI; hypothesis-generating and requires RCT confirmation before practice change.
BACKGROUND Many studies have demonstrated the benefit of complete multivessel revascularization versus culprit-only intervention in patients of ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease. However, only a few single-center retrospective studies were performed on small Chinese cohorts. Our study aims to demonstrate the advantage of multivessel percutaneous intervention (PCI) strategy on 30-day in-hospital outcomes to patients with STEMI and multivessel disease in larger Chinese population. METHODS From the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome (CCC-ACS) project, 5935 patients with STEMI and multivessel disease undergoing PCI and hospitalized for fewer than 30 days were analyzed. After 5: 1 propensity score matching, 3577 patients with culprit-only PCI and 877 with in-hospital multivessel PCI were included. The primary outcome was major adverse cardiovascular and cerebrovascular event (MACCE), defined as a composite of myocardial infarction, all-cause death, stent thrombosis, heart failure, and stroke. RESULTS Multivariable logistic regression analysis revealed that in-hospital multivessel PCI was associated with lower risk of 30-day MACCE (adjusted OR = 0.75, 95% CI: 0.57–0.98, P = 0.032) than culprit-only PCI and conferred no increased risk of all-cause death, myocardial infarction, stent thrombosis, stroke, or bleeding. Subgroup analysis showed that MACCE reduction was observed more often from patients with trans-femoral access (OR = 0.34, 95% CI: 0.15–0.74) than with trans-radial access (OR = 0.87, 95% CI: 0.66–1.16, P for interaction = 0.017). CONCLUSIONS The in-hospital multivessel PCI strategy was associated with a lower risk of 30-day MACCE than culprit-only PCI in patients with STEMI and multivessel coronary artery disease.
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Li et al. (2023) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease (n=5,935). In-hospital multivessel PCI vs. Culprit-only PCI was evaluated on Major adverse cardiovascular and cerebrovascular event (MACCE), defined as a composite of myocardial infarction, all-cause death, stent thrombosis, heart failure, and stroke (OR 0.75, 95% CI 0.57-0.98, p=0.032). In-hospital multivessel PCI was associated with a lower risk of 30-day MACCE than culprit-only PCI in patients with STEMI and multivessel disease (adjusted OR 0.75; 95% CI 0.57-0.98; P=0.032).
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