staged interventional strategies for acute st-segment elevation myocardial infarction patient with multi-vessel disease（staged）

Conditions: STEMI; Multi Vessel Coronary Artery Disease; Percutaneous Coronary Intervention

Summary: an investigator-initiated, randomized, multicenter, two-arm, open-label study of consecutive patients presenting with stemi and mvd objectives: the present study aimed to investigate the difference in all-cause mortality after in-hospital staged pci versus out-hospital staged pci for st-segment elevated myocardial infarction （stemi）patients with multi-vessel disease（mvd） background: in primary percutaneous coronary intervention for stemi with mvd, complete revascularization has proved to reduce the risk of cardiovascular death and myocardial infarction. however, a strategy of nonculprit-vessel pci with the goal of complete revascularization still not to be confirmed. compare with in-hospital staged pci, out-hospital pci as a strategy of nonculprit-vessel pci for stemi patients with mvd might have be beneficial results.

a total of 1700 subjects with stemi who met inclusion criteria and do not have any exclusion criterion will be randomized to in-hospital staged pci group and out-hospital staged pci group. after successful percutaneous coronary intervention for culprit lesion, all non-culprit vessel with significant lesion defined at least 80% diameter stenosis by visual estimation and accompanied by a qfr measurement of less than or equal to 0.80 will be performed complete revascularization. 1. patients randomized to in-hospital staged pci will have treated during the index procedure (7±3 days), after revascularization of the culprit lesion, all significant non-culprit coronary lesions. 2. patients randomized to out-hospital staged complete revascularization will have treated during the index procedure only the culprit lesion, and they will be hospitalized in 30±15 days for complete revascularization of all significant non-culprit coronary lesions.

Eligibility criteria:
inclusion criteria: * provision of informed consent prior to any study specific procedures; * established indication to ppci according to the guidelines of american heart association and american college of cardiology; * spontaneous acute stemi (patients presenting within 24 hours of symptom onset) with mvd after successful revascularization of the culprit artery; * de novo coronary lesion, * timi flow 3 ( cases with timi flow 2 need to perform angiographic again in 24h ensured timi flow 3 for enrolling case )after revascularization of the culprit artery, residual stenosis ≤20% and no coronary dissection greater than or equal to type c leading to (threatening) vessel closure. * at least one non-culprit coronary stenosis ≥ 80% and accompanied by qfr ≤0.8 in a vessel with a lumen diameter ≥2.5; exclusion criteria: * age \ 80 yr; * cardiac shock, multiple organ failure, cerebral hemorrhage, severe aortic stenosis and myocardial infarction complications(cardiac rupture, ventricular septal rupture and papillary muscle rupture); * killip classification \>3, cardiognic shock, shore-infarction of culprit artery after emergency pci in 24 hours; * previous documented allergic reaction to drug and device of this study; * planned major surgery within 6 weeks in which impact dapt; * participation in another clinical study, interfering with this protocol uncertain; * life expectancy \< 1 year; * any condition likely to interfere with study processes including follow-up visits or increase of risk accessed by researcher.