Immediate versus staged complete revascularization in a real-world cohort of patients with ST-elevation myocardial infarction and multivessel disease

Abstract Introduction Complete revascularization (CR) with percutaneous coronary (PCI) as compared with infarcted-related artery (IRA)-only in patients with Stelevation infarction (STEMI) and multivessel disease (MVD) has been consistently associated with lower risk of major adverse cardiac events (MACE). Whether CR should be performed in single or multi-stage procedures is still debated. Methods We sought to assess among a real-word ACS population enrolled in the prospective multi-center Special-Program-University-Medicine (SPUM, NCT01000701) the impact of staged CR (sCR) on 1-year MACE (cardiovascular death, non-fatal myocardial infarction, non-fatal stroke). MVD was defined s significant stenosis (>70%) in two or more major epicardial coronary arteries. Results Out of 4787 ACS-patients, 721 (15.1%) had STEMI with MVD; of these 505 (70.0%) underwent sCR. Baseline characteristics did not differ between groups. Patients undergoing iCR presented more frequently Killip class III-IV (7.7% vs 5.4%, p=0.008) and increased inflammatory indexes (NLR , 6.8±5.9 vs 5.8±5.1 mmol/l, p =0.025). Patients who underwent sCR compared with iCR had lower rates of in-hospital MACE (2.6% vs 6.5%, p=0.013), only numerical reduced at 1 year (4.8% vs 7.9%, p=0.072). sCR was associated with reduced risk of all-cause mortality at 1-year, that persisted after adjustment for confounding factors (Adj. HR 0.33, 95%CI 0.13-0.82, p=0.018). No differences in terms of MACE was detected between early (<7 days) and late CR. Conclusions In real-word ACS patients with STEMI and MVD, sCR is associated with a lower rate of in-hospital MACE compared to iCR, without differences in the long term. No differences was detected between early and late CR. These data have to be confirmed in larger and dedicated trials.Kaplan Maier Events Rates for DeathFor image description, please refer to the figure legend and surrounding text.