December 13, 2007Journal of Interventional Cardiology
Management of Multivessel Coronary Disease after ST Elevation Myocardial Infarction Treated by Primary Angioplasty
Key result
Early, staged PCI of non-culprit lesions in STEMI patients was associated with lower out-of-hospital MACE (9.3% vs 23.9%, P=0.037) but higher in-hospital MACE (20.3% vs 10.8%, P=0.186).
Why the study?
Does early, staged PCI of non-culprit lesions reduce MACE in patients with STEMI and multivessel CAD treated by primary angioplasty?
Population
110 patients with ST elevation myocardial infarction and multivessel coronary artery disease treated by…
Comparison
Early, staged percutaneous coronary intervention… vs Primary angioplasty without early, staged PCI of…
Design
Cohort
Follow-up
mean 13 months (392 +/- 236 days)
Authors
Discussion
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Member takes
Implication
Should not yet change practice in STEMI with multivessel disease; leaves open the net benefit of staged non-culprit PCI for randomized confirmation.
Study Design
Type
Cohort (n=110)
Structured PICO
Does early, staged PCI of non-culprit lesions reduce MACE in patients with STEMI and multivessel CAD treated by primary angioplasty?
P
Population
110 patients with STEMI and multivessel CAD treated by primary angioplasty, followed for a mean of 13 months.
E
Exposure
Early, staged percutaneous coronary intervention (PCI) of other angiographically significant coronary lesions (performed 5.9 +/- 3.5 days after primary angioplasty)
C
Comparator
Primary angioplasty without early, staged PCI of other angiographically significant coronary lesions
O
Outcome
In-hospital MACE (composite of death, periprocedural myocardial infarction after staged, elective PCI, stroke, stent thrombosis, major bleeding, and vascular complications) and MACE at follow-up (composite of death, stroke, stent thrombosis, any coronary revascularization, and re-hospitalization for acute coronary syndrome)composite
Main Result
Absolute Event Rate: 9.3% vs 23.9%
p-value: p=0.037
Early staged PCI of non-culprit lesions in STEMI patients with multivessel disease reduces long-term MACE but is associated with increased in-hospital periprocedural myocardial infarction.
Cite This Study
Rigattieri et al. (2007) conducted a cohort in ST elevation myocardial infarction (STEMI) and multivessel coronary artery disease (CAD) (n=110). Early, staged PCI of non-culprit lesions vs. Primary angioplasty without early, staged PCI was evaluated on Out of hospital MACE (composite of death, stroke, stent thrombosis, any coronary revascularization, and re-hospitalization for acute coronary syndrome) (p=0.037). Early, staged PCI of non-culprit lesions in STEMI patients was associated with lower out-of-hospital MACE (9.3% vs 23.9%, P=0.037) but higher in-hospital MACE (20.3% vs 10.8%, P=0.186).