Key result
Complete revascularization shows no MACE benefit over IRA-only PCI at 12 months but cuts recurrent angina.
Why the study?
The optimal strategy for treatment of non-infarct-related artery lesions during primary PCI in ST-elevation MI patients with multi-vessel disease remains unclear.
Does primary PCI for IRA followed by elective PCI for non-IRA improve outcomes compared to PCI for IRA only in patients with STEMI and multi-vessel disease?
Population
242 patients with ST-elevation MI and multi-vessel disease undergoing primary PCI
Comparison
Primary PCI for IRA only vs primary PCI for IRA followed by elective PCI for non-IRA
Design
Observational cohort study
Follow-up
12 months
Authors
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Staged complete revascularization may reduce angina without MACE difference in STEMI multivessel disease; leaves open whether RCTs will confirm benefit on hard endpoints.
Observational (n=242)
Does primary PCI for IRA followed by elective PCI for non-IRA improve outcomes compared to PCI for IRA only in patients with STEMI and multi-vessel disease?
Absolute Event Rate: 15.1% vs 11.5%
p-value: p=> 0.05
In STEMI patients with multi-vessel disease, staged complete revascularization did not significantly reduce 12-month MACE but improved LVEF and reduced recurrent angina compared to culprit-only PCI.
Han et al. (2008) conducted an observational in ST-elevation myocardial infarction and multi-vessel disease (n=242). Primary PCI for infarct-related artery followed by elective PCI for non-infarct-related artery vs. Primary PCI for infarct-related artery only was evaluated on Major adverse cardiac events (p=> 0.05). Complete revascularization with elective PCI for non-IRA after primary PCI resulted in similar 12-month MACE rates compared to IRA-only PCI (15.1% vs 11.5%, P>0.05) but reduced recurrent angina.
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