Key result
Complete revascularization of non-culprit lesions during index primary PCI resulted in identical one-year rates of all-cause death (4%, HR 0.979) compared to a staged procedure during the same hospital admission in patients with STEMI and multi-vessel disease.
Why the study?
The optimal timing of complete revascularization—during primary PCI versus during the index hospital admission—in patients with multivessel disease and STEMI uncomplicated by cardiogenic shock remained uncertain.
Does complete revascularization during index primary PCI reduce death or MACCE compared to staged complete revascularization during the same hospital admission in patients with STEMI and multi-vessel disease?
RCT (n=100)
Single-blind
1:1
No
Does complete revascularization during index primary PCI reduce death or MACCE compared to staged complete revascularization during the same hospital admission in patients with STEMI and multi-vessel disease?
Hazard Ratio: 0.979 (95% CI 0.13–6.95)
Absolute Event Rate: 4% vs 4%
p-value: p=0.983
In patients with STEMI and multi-vessel disease, complete revascularization during the index primary PCI yields similar 1-year outcomes compared to a staged procedure during the same hospital admission.
Supports clinician choice of index or staged in-hospital complete revascularization; extends RCT evidence on non-culprit PCI timing in STEMI.
OBJECTIVE: In this study, we aimed to compare major adverse cardiac and cerebrovascular events (MACCE), defined as a composite of death, stroke, myocardial infarction and symptom-induced revascularization, and mortality within one year of randomization between two strategies; complete revascularization including non-culprit lesions percutaneous coronary intervention (PCI) during primary PCI (PPCI) versus complete revascularization during the same hospital admission in patients with multi-vascular coronary artery disease (MVD) presenting with ST-elevation myocardial infarction (STEMI) uncomplicated by cardiogenic shock. METHODS: We randomized in a 1: 1 manner 100 patients with MVD and STEMI uncomplicated by cardiogenic shock who had undergone successful culprit-lesion PCI to either a strategy of complete revascularization with PCI of angiographically significant non-culprit lesions in the index PPCI procedure or to a strategy of complete revascularization during a second procedure that took place during the same hospital admission. RESULTS: The first primary outcome was death within a timeframe of one year and the second a composite of MACCE within a year following complete revascularization. Of the total number of patients monitored, 4% in each of the two groups was associated with the first primary outcome (p=0.984) and the second primary outcome in 6% (p=0.970). There was no statistical difference between outcomes in the two groups. CONCLUSION: Among patients with MVD and STEMI uncomplicated by cardiogenic shock, there was no difference regarding outcomes when using a strategy of complete revascularization of non-culprit lesions during PPCI or the same hospital admission.
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Brendea et al. (2021) conducted an RCT in Multi-vessel coronary artery disease and STEMI (n=100). Complete revascularization during index primary PCI vs. Complete revascularization in a staged procedure during the same hospital admission was evaluated on All-cause death at one year (HR 0.979, 95% CI 0.13-6.95, p=0.983). Complete revascularization of non-culprit lesions during index primary PCI resulted in identical one-year rates of all-cause death (4%, HR 0.979) compared to a staged procedure during the same hospital admission in patients with STEMI and multi-vessel disease.
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