Immediate versus staged complete revascularization in patients with ST-segment elevation myocardial infarction and multivessel coronary artery disease: results from a prematurely discontinued randomized multicenter trial - 06/04/23
, Byoung Geol Choi, PhD 2, Jang Hyun Cho, MD, PhD 3, Sang Ho Park, MD, PhD 4, Jin Bae Lee, MD, PhD 5, Yong Hoon Kim, MD, PhD 6, Sang Min Park, MD, PhD 7, Jae Woong Choi, MD, PhD 7, Ji Young Park, MD, PhD 7, Eun-Seok Shin, MD, PhD 8, Jae Beom Lee, MD 9, Jon Suh, MD, PhD 10, Jei Keon Chae, MD, PhD 11, Young Jin Choi, MD, PhD 12, Myung Ho Jeong, MD, PhD 13, Kwang soo Cha, MD, PhD 14, Seung Wook Lee, MD, PhD 15, Ung Kim, MD, PhD 16, Gi Chang Kim, MD, PhD 17, Woong-Gil Choi, MD, PhD 18, Yun-Hyeong Cho, MD, PhD 19, Deok-kyu Cho, MD, PhD 20, Jihun Ahn, MD, PhD 21, Soon-Yong Suh, MD, PhD 22, Se Yeon Choi, PhD 2, Jae Kyeong Byun, PhD 2, Jin Ah Cha, BS 2, Soo Jin Hyun, BS 2, Ji Bak Kim, MD, PhD 1, Cheol Ung Choi, MD, PhD 1, Chang Gyu Park, MD, PhD 1Abstract |
Background |
We aimed to compare clinical outcomes between immediate and staged complete revascularization in primary percutaneous coronary intervention (PCI) for treating ST-segment elevation myocardial infarction (STEMI) and multivessel disease (MVD).
Methods |
A total of 248 patients were enrolled in a prospective, randomized, and multicenter registry. Immediate revascularization was defined as one-time PCI of culprit and non-culprit lesions at the initial procedure. Staged revascularization was defined as PCI of non-culprit lesions at a later date (mean, 4.4 days; interquartile range, 1–11.4), following initial culprit revascularization. The end points were major adverse cardiovascular events (MACE; composite of total death, recurrent myocardial infarction, and revascularization), any individual components of MACE, cardiac death, stent thrombosis, and stroke at 12 months.
Results |
During a follow-up of 1 year, MACE occurred in 12 patients (11.6%) in the immediate revascularization group and in 8 patients (7.5%) in staged revascularization group (hazard ratio [HR] 1.60, 95% confidence interval [CI] 0.65–3.91). The incidence of total death was numerically higher in the immediate group than in the staged group (9.7% vs 2.8%, HR 3.53, 95% CI 0.97–12.84); There were no significant differences between the 2 groups in risks of any individual component of MACE, cardiac death, stroke, and in-hospital complications, such as need for transfusion, bleeding, acute renal failure, and acute heart failure. This study was prematurely terminated due to halt of production of everolimus-eluting stents (manufactured as PROMUS Element by Boston Scientific, Natick, Massachusetts).
Conclusions |
Due to its limited power, no definite conclusion can be drawn regarding complete revascularization strategy from the present study. Further large randomized clinical trials would be warranted to confirm optimal timing of complete revascularization for patients with STEMI and MVD.
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| Please refer to this study by its ClinicalTrials.gov identifier: NCT01180218 |
Vol 259
P. 58-67 - maggio 2023 Ritorno al numero
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