Comparative Effectiveness of Complete Revascularization versus Infarct Related Artery-only Percutaneous Coronary Revascularization for Multivessel Disease after ST-Segment Elevation Myocardial Infarction
Authors: Jayaraj Joshua Chadwick , Abrahamyan Lusine , Demirchyan Anahit 
Published: November 2016

<p class="MsoNormal" style="margin-bottom: .0001pt; line-height: 200%; mso-layout-grid-align: none; text-autospace: none;"><strong><span style="font-size: 12.0pt; line-height: 200%; font-family: 'Times New Roman','serif';">Objectives:</span></strong><span style="font-size: 12.0pt; line-height: 200%; font-family: 'Times New Roman','serif';"> The purpose of this study was to evaluate the event free survival from major adverse cardiac events (MACE) for ST-segment elevation myocardial infarction (STEMI) patients with multivessel disease as a function of whether they underwent infarct-related artery (IRA) only percutaneous coronary intervention (PCI) or complete revascularization at index admission.</span></p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: 200%; mso-layout-grid-align: none; text-autospace: none;"><strong><span style="font-size: 12.0pt; line-height: 200%; font-family: 'Times New Roman','serif';">Background</span></strong><span style="font-size: 12.0pt; line-height: 200%; font-family: 'Times New Roman','serif';">: The optimal management of patients with STEMI and multivessel disease while undergoing primary percutaneous coronary intervention (P-PCI) is uncertain.</span></p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: 200%; mso-layout-grid-align: none; text-autospace: none;"><strong><span style="font-size: 12.0pt; line-height: 200%; font-family: 'Times New Roman','serif';">Methods and Results: </span></strong><span style="font-size: 12.0pt; line-height: 200%; font-family: 'Times New Roman','serif';">STEMI patients with multivessel disease undergoing P-PCI between April 1, 2012, and March 31, 2014, were subdivided into those who underwent in-hospital complete revascularization (n= 150) or IRA-only revascularization (n = 156). Complete revascularization was performed during the index admission of P-PCI. The primary endpoint was a composite of all-cause death, recurrent myocardial infarction (MI), heart failure, and ischemia-driven revascularization within 24 months. Patient groups were differed at baseline by gender and prevalence of </span><span style="font-size: 12.0pt; line-height: 200%; font-family: 'Times New Roman','serif'; mso-ansi-language: EN-CA;" lang="EN-CA">heart failure</span><span style="font-size: 12.0pt; line-height: 200%; font-family: 'Times New Roman','serif';">. 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 23% in the IRA-only revascularization group (hazard ratio: 0.51; 95% confidence interval: 0.34 to 0.93; p =0.039). There was a significant reduction in death, a non-significant reduction in all primary endpoint components was seen. </span></p><strong><span style="font-size: 12.0pt; line-height: 115%; font-family: 'Times New Roman','serif'; mso-fareast-font-family: 'Times New Roman'; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: EN-US;">Conclusions:</span></strong><span style="font-size: 12.0pt; line-height: 115%; font-family: 'Times New Roman','serif'; mso-fareast-font-family: 'Times New Roman'; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: EN-US;"> In patients presenting for P-PCI with multivessel disease, index admission complete revascularization significantly lowered the rate of the primary composite endpoint at 24 months compared with treating only the IRA. </span>