Clinical effectiveness of complete revascularization versus infarct-related artery-only percutaneous coronary revascularization for multivessel disease ST-segment elevation myocardial infarction

Abstract

Objectives: The purpose of this study was to evaluate the event-free survival from major adverse cardiac events for ST-segment elevation myocardial infarction (STEMI) patients with multivessel disease (MVD) as a function of whether they underwent infarct-related artery (IRA)- only percutaneous coronary intervention (PCI) or complete revascularization at index admission. Background: The optimal management of patients with STEMI and MVD while undergoing primary PCI (P-PCI) is uncertain. Methods and Results: STEMI patients with MVD undergoing P-PCI between April 1, 2012, and March 31, 2014, were subdivided into those who underwent complete revascularization during index admission (n = 150) and IRA-only revascularization (n = 156). Complete revascularization was performed at index admission of P-PCI. The primary endpoint was a composite of all-cause death, recurrent MI, heart failure (HF), and ischemia-driven revascularization within 24 months. Patient groups were differed at baseline by gender and prevalence of HF. The average door-to-balloon time was significantly higher in the complete revascularization group. The primary endpoint occurred in 11.0% of the complete revascularization group versus in 23% of the IRA-only revascularization group (hazard ratio: 0.51; 95% confidence interval: 0.34–0.93; P = 0.039). There was a significant reduction in death; a nonsignificant reduction in all primary endpoint components was seen. Conclusions: In patients presenting for P-PCI with MVD, complete revascularization at index admission significantly lowered the rate of the primary composite endpoint at 24 months compared with treating IRA-only.