Key result
Immediate non-culprit PCI shows no significant benefit over staged PCI in STEMI with renal dysfunction.
Why the study?
Renal dysfunction might affect outcomes in patients with STEMI and multivessel coronary artery disease undergoing PCI of non-culprit lesions.
Does immediate versus staged PCI of non-culprit lesions alter the 1-year composite outcome in patients with STEMI and multivessel disease stratified by baseline renal dysfunction?
RCT (n=832)
Randomized to immediate or staged PCI of non-culprit lesions (pre-specified subgroup analysis stratified by baseline renal dysfunction)
Does immediate versus staged PCI of non-culprit lesions alter the 1-year composite outcome in patients with STEMI and multivessel disease stratified by baseline renal dysfunction?
In patients with STEMI and multivessel disease, baseline renal dysfunction increases 1-year adverse event and acute kidney injury risks, but does not significantly modify the comparative effectiveness or renal safety of immediate versus staged multivessel PCI.
No interaction by renal function on primary endpoint; leaves open whether immediate non-culprit PCI benefits the renal-dysfunction subgroup.
Background Renal dysfunction might affect outcomes in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease (MVD) undergoing percutaneous coronary intervention (PCI). Methods In MULTISTARS AMI, patients with STEMI and MVD were randomized to immediate or staged PCI of non-culprit lesions. In this pre-specified analysis, patients were stratified according to the presence of renal dysfunction at baseline, defined at an estimated glomerular filtration rate (eGFR) of 60 ml/min/1.73 m 2 . Patients with an eGFR < 30 ml/min/1.73 m 2 were excluded from the trial. The primary endpoint was a composite of death, non-fatal myocardial infarction, stroke, unplanned revascularization, or hospitalization for heart failure at 1 year. Results In MULTISTARS AMI, 108 (13%) of 832 patients had renal dysfunction. The primary endpoint occurred more frequently in patients with renal dysfunction (19.4% vs. 11.2%, unadjusted HR 1.82, 95% CI 1.13–2.94), primarily driven by higher rates of death. Among patients with renal dysfunction, the rates of the primary end point were 14.5% and 24.5% in the immediate and staged PCI groups (unadjusted HR 0.55, 95% CI 0.23–1.33). There was no interaction between renal dysfunction and the randomized treatment assignment with respect to the primary end point (adjusted HR 1.30, 95% CI 0.8–2.20, p int 0.82). The occurrence of acute renal insufficiency was statistically similar in patients with renal dysfunction who underwent immediate and staged PCI (10.9% vs. 18.9%, unadjusted HR 0.61, 95% CI 0.22–1.72, p int 0.09). Renal dysfunction at baseline emerged as a strong risk factor for the development of acute renal insufficiency (adjusted HR 5.0, 95% CI 2.30–10.70, p < 0.01). Conclusions Outcomes with immediate compared to staged multivessel PCI did not appear significantly altered by the presence of renal dysfunction at baseline. (Supported by Boston Scientific; MULTISTARS AMI ClinicalTrials.gov number, NCT03135275).
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Rohla et al. (2026) conducted an RCT in ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease (MVD) (n=832). Immediate percutaneous coronary intervention (PCI) of non-culprit lesions vs. Staged percutaneous coronary intervention (PCI) of non-culprit lesions was evaluated on Composite of death, non-fatal myocardial infarction, stroke, unplanned revascularization, or hospitalization for heart failure at 1 year (HR 0.55, 95% CI 0.23-1.33, p=0.82 for interaction). Immediate vs staged non-culprit PCI in STEMI with renal dysfunction had 1-year composite event rates of 14.5% vs 24.5% (HR 0.55; 95% CI 0.23-1.33; P_interaction=0.82).
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