Abstract 11639: Multivessel Versus Culprit-only Revascularization for Patients With St-segment Elevation Myocardial Infarction and Multivessel Disease Undergoing Primary Percutaneous Coronary Intervention

Abstract

Introduction: Primary percutaneous coronary intervention (PCI) to recanalize the infarct related artery (IRA) has become the first-choice therapy for ST-segment elevation myocardial infarction (STEMI) during past decades, while the value and optimal timing for PCI in non-IRA with stenosis is unknown. Objective: To examine the long-term outcomes and timing strategy for complete revascularization. Methods: 1,039 STEMI patients with multivessel disease were divided into who received only-IRA PCI (555 patients) or complete revascularization including immediate PCI during the index-procedure (57 patients) or staged PCI within 90 days from the index-procedure (427 patients). The primary outcome was a composite of cardiac death, myocardial reinfarction, ischemic stroke or repeat revascularization. Results: During a mean follow-up of 47 months, the primary outcome occurred in 146 patients with only-IRA PCI and 102 patients with complete revascularization respectively (HR for complete revascularization,0.633;95%CI,0.445-0.900; P =0.011). This benefit mainly showed on the decreased risk for cardiac death, MI and repeat revascularization. The differences of the primary outcome between immediate PCI and staged PCI was non-significant (HR, 3.910;95%CI,0.852-17.949; P =0.079), but staged time interval was associated with risk-adjusted outcomes (HR 0.886;95%CI,0.797-0.984; P =0.024). A further analysis suggested 10 days or later could be a safe cutoff point for PCI in non-IRA (HR, 0.213;95%CI,0.063-0.717; P =0.013). Conclusion: In patients presenting for primary PCI with multivessel disease, complete revascularization significantly lowered the rate of the long-term endpoint compared with treating only the IRA. The optimal time for treating non-IRA assigned over 10 days after the index-procedure could improve survival.