Optimal Timing of Angiography-Guided Complete Revascularization of Non-Culprit Lesions in STEMI Patients with Multivessel Disease

TL;DR

This study found that doing complete revascularization during the first procedure for STEMI patients with multivessel disease leads to better outcomes than doing it in a later procedure.

Contribution

The study provides new evidence on the optimal timing for revascularizing non-culprit lesions in STEMI patients with multivessel disease.

Findings

Index PCI had a lower 12-month MACCE rate (11.9%) compared to staged PCI (32.1%).

In-hospital MACCE was also lower in the index PCI group (8.5%) than in the staged PCI group (25%).

Index PCI showed a trend toward better outcomes for death, MI, revascularization, and new angina.

Abstract

Background: There are many questions regarding the optimal approach to treating non-culprit lesions in STEMI patients. Several questions still need to be answered, such as identifying the lesions to be revascularized and the optimal timing. Methods: We conducted a single-center analysis. The primary outcome was the incidence of major cardiovascular and cerebral adverse events (MACCE) at 12 months in patients with STEMI and multivessel disease (MVD) who achieved complete revascularization during the index procedure or with a staged procedure. The secondary outcomes were death from any cause, myocardial infarction, target lesion revascularization, stroke, major bleeding events, new angina episodes, new hospitalization, and in-hospital MACCE. Results: From January 2021 to December 2022, a total of 230 patients with STEMI underwent primary PCI in our department; 87 patients had MVD. Fifty-nine patients (67.8%) underwent a non-culprit revascularization strategy during the index procedure strategy, and 28 patients (32.2%) during a staged procedure. The incidence of MACCE at 12 months was 11.9% (seven patients) in the index PCI group, compared with 32.1% (nine patients) in the staged PCI group (odds ratio, 3.52; 95% CI, 1.15 to 10.77; p = 0.022). In-hospital MACCE occurred in five patients (8.5%) of the index PCI group, compared with seven patients (25%) in the staged PCI group (odds ratio, 3.60; 95% CI, 1.03 to 12.61; p = 0.036). A trend towards better outcomes favoring the index PCI group was observed with death from any cause, myocardial infarction, target lesion revascularization, and new angina episodes. Conclusions: Better outcomes were evident with an index PCI strategy than with a staged PCI strategy for complete revascularization in patients with STEMI and MVD.

Figures