Staged Complete Revascularization vs. Culprit Vessel PCI at Long-Term

Staged complete revascularization in patients with acute myocardial infarction and multivessel coronary disease is superior to culprit PCI only at five-year follow-up.

The outcomes of this retrospective analysis show the benefit of staged PCI, though it might be attenuated in diabetic patients. Outcomes are consistent with previously published randomized studies.

Nevertheless, we should remain cautious when interpreting this study in particular, since it is an observational study on “real world” patients and could be full of confounding factors. For instance, why some patients received complete revascularization and others did not; there must have been reasons behind the difference in results.

Read also: Bariatric Surgery Associated with a Lower Rate of Mortality Due to Infarction and Stroke.

Neither does the study offer answers as regards the best moment to complete revascularization (when stages should be).

This study was recently published in the American Journal of Cardiology. It included 1205 patients undergoing ST elevation MI and multivessel disease. Around half of patients received staged PCI and the rest only culprit PCI.

Propensity score matching was used to compare groups, leaving 415 patients with similar baseline characteristics in each branch.

Read also: New Percutaneous Devices to Prevent Embolism in Atrial Fibrillation.

After a 5-year follow-up, MACCE rate was lower (all cause death, MI, stroke, and unplanned revascularization) and it resulted 30.6% for the complete revascularization groups vs 34.5% for the culprit PCI group (HR 0.7, CI 95% 0.55 to 0.89). Patients in the complete revascularization group tended to present less MI and unplanned revascularization.

Outcomes were consistent in most subgroups except for diabetic patients. These group did not present lower MACCE rate regardless the strategy.

Patients with 3 vessel disease showed a more pronounced Benefit than the general population.

The studies COMPLETE and FULL REVASC, to be published soon, are expected to look further into this and make the guidelines give more specific recommendations.

Original Title: Long-term safety and efficacy of staged percutaneous coronary intervention for patients with ST-segment elevation myocardial infarction and multivessel coronary disease.

Reference: Cui K et al. Am Heart J. 2019; Epub ahead of print.

We are interested in your opinion. Please, leave your comments, thoughts, questions, etc., below. They will be most welcome.