Immediate versus Staged Complete Revascularization in Multi-Vessel Coronary Artery Disease Patients with ST-Elevation Myocardial Infarction Uncomplicated by Cardiogenic Shock

Background: Although Primary Percutaneous Coronary Intervention (PPCI) has been established as the best treatment for ST-Elevation Myocardial Infarction (STEMI), there is a gap in the evidence about the optimal time when non-Infarct Related Artery (IRA) lesions should be revascularized.

Objectives: The first primary outcome was defined as death within a timeframe of one year from the complete revascularization. The second primary outcome was a composite of Major Adverse Cardiac and Cerebrovascular events (MACCE) within a year following complete revascularization. Overall, the study aimed to compare the two study groups (patients with multi-vessel coronary artery disease (MVD) presenting with STEMI uncomplicated by cardiogenic shock, in which complete revascularization was attained using either complete revascularization during the PPCI (group A) or during the same hospital admission (group B)) regarding the occurrence of the above-mentioned outcomes.

Methods: This single-center, retrospective study aimed to review the outcomes in two groups, each consisting of 50 consecutive MVD patients with STEMI uncomplicated by cardiogenic shock. The patients included in the trial underwent successful culprit-lesion Percutaneous Coronary Intervention (PCI) between 1 January 2017 and 1 June 2019. Then, they underwent complete revascularization with either PCI of all angiographically significant non-culprit lesions in the index PPCI procedure (group A) or during a second procedure that took place during the same hospital admission (group B).

Results: The first primary outcome was observed in 4% of the whole study population (n = b2, P = 0.98), while the second primary outcome was detected in 6% of the patients (n = 3, P = 0.97). The results revealed no significant difference between the two groups concerning the outcomes.

Conclusions: Among the MVD patients with STEMI uncomplicated by cardiogenic shock, there was no significant difference regarding the outcomes when using the complete revascularization of non-culprit lesions during PPCI and in a second PCI session at the same hospital admission.