Culprit-vessel only versus complete percutaneous coronary intervention for ST-segment elevation myocardial infarction patients presenting with multivessel disease
Xu Xiaoming
Li Chao
Qiu Miaohan
Wen Liang
Wang Heyang
Li Yi
Cheng Kang
Abstract：Objective To explore the impact of culprit-vessel only percutaneous coronary intervention (PCI) versus complete PCI on clinical outcomes of patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease (MVD) in China. Methods We retrospectively analyzed a total of 326 patients who presented with STEMI and MVD and who were admitted in the intensive care unit of cardiology of Xijing Hospital from January 1, 2009 to June 30, 2014. MVD was defined as the presence of stenosis of 70% or greater in at least two or more major epicardial coronary artery (with diameter ≥ 2.0 mm). After completing percutaneous revascularization of the culprit vessel within 12 hours of onset, 131 patients agreed to undergo revascularization of the non-culprit arteries during the same procedure of the primary PCI or at 1 to 60 days after the primary PCI (complete revascularization). Then a total of 195 patients received PCI only for the culprit vessel in our study. The primary endpoint was a composite of cardiac death, recurrent myocardial infarction, ischemia-driven revascularization and heart failure within 3 years after the primary or staged PCI. Other endpoints included the components of the primary endpoints, all-cause death, refractory angina and all bleedings (BARC 1~5) at 3 years follow-up. Results Compared to a culprit-vessel only revascularization strategy, the complete revascularization resulted in a lower rate of MACE (17.6% vs. 30.8%, P=0.005), cardiac death (1.5% vs. 7.7%, P=0.029), heart failure (1.5% vs. 7.2%, P=0.031) and all-cause death (2.3% vs. 9.2%, P=0.022). The rates of recurrent myocardial infarction (3.8% vs. 2.6%, P=0.622), ischemia-driven revascularization (14.5% vs. 17.9%, P=0.246), refractory angina (24.4% vs. 27.2%, P=0.332) and all bleedings (3.8% vs. 3.1%, P=0.793) were similar between the two strategies. Conclusions Compared to the strategy of culprit-vessel only revascularization, the complete revascularization for patients with STEMI and MVD could significantly reduce the risk of MACE at 3 years follow-up. And the benefits were mainly driven by the reduction of cardiac death and heart failure in the complete PCI group.
Keywords：ST-segment elevation myocardial infarctionMultivessel diseaseComplete PCICulprit-vessel only PCIMajor adverse cardiovascular disease
Publication Date：2018-01-01
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：5( 1305-1309 )