Key result
Complete revascularization did not significantly reduce the 3-year patient-oriented composite outcome compared to incomplete revascularization in STEMI patients with reduced LVEF (26.0% vs 33.1%; P=0.275).
Why the study?
The benefit of complete revascularization in STEMI patients with left ventricular dysfunction is uncertain.
Does complete revascularization improve clinical outcomes in STEMI patients with multivessel coronary artery disease and reduced LVEF?
Cohort (n=1,314)
Does complete revascularization improve clinical outcomes in STEMI patients with multivessel coronary artery disease and reduced LVEF?
Absolute Event Rate: 26% vs 33.1%
p-value: p=0.275
Complete revascularization may not improve three-year clinical outcomes in STEMI patients with multivessel disease and reduced LVEF (<40%), in contrast to the significant benefits observed in those with preserved LVEF.
May not improve outcomes in reduced-LVEF STEMI; leaves open differential effect versus preserved LVEF and requires RCTs.
The benefit of complete revascularization (CR) in ST-segment elevation myocardial infarction (STEMI) patients with left ventricular (LV) dysfunction is uncertain. A total of 1314 STEMI patients with multivessel coronary artery disease were analyzed. CR was defined angiographically and by a residual Synergy between PCI with Taxus and Cardiac Surgery trial (SYNTAX) score (SS) <8. Patients with a left ventricular ejection fraction (LVEF) <40% were classified as the reduced LVEF group. The major study endpoints were patient-oriented composite outcome (POCO) and cardiac death during three-year follow-up. Overall, patients that received angiographic CR (579 patients, 44.1%) had significantly lower three-year clinical events compared with incomplete revascularization (iCR). CR reduced three-year POCO and cardiac death rates in the preserved LVEF group (POCO: 13.2% vs. 21.9%, p < 0.001, cardiac death: 1.8% vs. 6.5%, p < 0.001, respectively) but not in the reduced LVEF group (POCO: 26.0% vs. 33.1%, p = 0.275, cardiac death: 15.1% vs. 19.0%, p = 0.498, respectively). Multivariate analysis showed that CR significantly reduced three-year POCO (hazard ration (HR) 0.59, 95% confidence interval (CI) 0.43–0.82) and cardiac death (HR 0.34, 95% CI 0.14–0.80), only in the preserved LVEF group. Additionally, the results were corroborated using the SS-based CR definition. In STEMI patients with multivessel disease, CR did not improve clinical outcomes in those with reduced LVEF.
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Kang et al. (2020) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) with multivessel coronary artery disease (n=1,314). Complete revascularization vs. Incomplete revascularization was evaluated on Patient-oriented composite outcome (POCO) in patients with reduced LVEF (<40%) (p=0.275). Complete revascularization did not significantly reduce the 3-year patient-oriented composite outcome compared to incomplete revascularization in STEMI patients with reduced LVEF (26.0% vs 33.1%; P=0.275).
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