Key result
Multi-staged PCI linked to ~58% lower 1-year mortality versus single-staged PCI in multi-vessel STEMI.
Why the study?
Although complete revascularization is superior to incomplete revascularization in STEMI patients with multi-vessel coronary artery disease, the optimal timing of non-culprit lesion PCI remains undefined.
Does single-staged PCI compared to multi-staged PCI improve 1-year clinical outcomes in patients with STEMI and multi-vessel coronary artery disease?
Cohort (n=606)
Yes
Does single-staged PCI compared to multi-staged PCI improve 1-year clinical outcomes in patients with STEMI and multi-vessel coronary artery disease?
Hazard Ratio: 0.42 (95% CI 0.19–0.92)
Absolute Event Rate: 3.4% vs 10.6%
p-value: p=0.030
In patients with STEMI and multi-vessel disease, multi-staged PCI is associated with lower 1-year all-cause mortality compared to single-staged complete revascularization, particularly in high-risk patients.
Multi-staged PCI was associated with lower 1-year mortality than single-staged; leaves open optimal timing in randomized trials.
BACKGROUND AND OBJECTIVES: Although complete revascularization is known superior to incomplete revascularization in ST elevation myocardial infarction (STEMI) patients with multi-vessel coronary artery disease (MVCD), there are no definite instructions on the optimal timing of non-culprit lesions percutaneous coronary intervention (PCI). We compared 1-year clinical outcomes between 2 different complete multi-vessel revascularization strategies. METHODS: From the Korea Acute Myocardial Infarction Registry-National Institute of Health, 606 patients with STEMI and MVCD who underwent complete revascularization were enrolled from November 2011 to December 2015. The patients were assigned to multi-vessel single-staged PCI (SS PCI) group (n=254) or multi-vessel multi-staged PCI (MS PCI) group (n=352). Propensity score matched 1-year clinical outcomes were compared between the groups. RESULTS: At one year, MS PCI showed a significantly lower rate of all-cause mortality (hazard ratio [HR], 0.42; 95% confidential interval [CI], 0.19-0.92; p=0.030) compared with SS PCI. In subgroup analysis, all-cause mortality increased in SS PCI with cardiogenic shock (HR, 4.60; 95% CI, 1.54-13.77; p=0.006), age ≥65 years (HR, 4.00; 95% CI, 1.67-9.58, p=0.002), Killip class III/IV (HR, 7.32; 95% CI, 1.68-31.87; p=0.008), and creatinine clearance ≤60 mL/min (HR, 2.81; 95% CI, 1.10-7.18; p=0.031). After propensity score-matching, MS PCI showed a significantly lower risk of major adverse cardiovascular event than SS PCI. CONCLUSIONS: SS PCI was associated with worse clinical outcomes compared with MS PCI. MS PCI for non-infarct-related artery could be a better option for patients with STEMI and MVCD, especially high-risk patients.
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Ahn et al. (2020) conducted a cohort in ST elevation myocardial infarction with multi-vessel coronary artery disease (n=606). Multi-staged percutaneous coronary intervention (MS PCI) vs. Single-staged percutaneous coronary intervention (SS PCI) was evaluated on All-cause mortality at 1 year (HR 0.42, 95% CI 0.19-0.92, p=0.030). Multi-staged PCI significantly reduced the risk of 1-year all-cause mortality (HR 0.42) compared with single-staged PCI in patients with STEMI and multi-vessel coronary artery disease.
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