ISSN 2996-8215
International Journal of Cardiology | Vol. 8, No. 4, April 2017 | pp. 25–32
DOI: 10.46882/2017/IJC/000097
Original Research Article
Complete versus Culprit-Only Revascularization in Patients with Multivessel Disease Undergoing Primary PCI for STEMI
Jean-Claude Moreau¹, Philippe Laurent¹, Henri Dupont²
¹Department of Interventional Cardiology, Hôpital Européen Georges-Pompidou, Paris, France
²Division of Cardiovascular Medicine, Centre Hospitalier Universitaire de Lyon, Lyon, France
Abstract:
Approximately 40% to 50% of patients presenting with acute ST-segment elevation myocardial infarction (STEMI) exhibit multivessel coronary artery disease (MVD). The optimal interventional management strategy for non-culprit obstructive lesions during the acute phase remains an area of clinical debate. This prospective randomized trial compared the 1-year clinical outcomes of complete revascularization versus culprit-only revascularization during primary percutaneous coronary intervention (PPCI) for STEMI. We randomized 240 patients presenting with STEMI and documented MVD into two distinct treatment arms: complete revascularization (PPCI of the culprit lesion followed by staged PCI of non-culprit stenoses within 7 days of index presentation, n = 120) or culprit-only revascularization (PPCI restricted strictly to the infarct-related artery, n = 120). The primary endpoint was the 1-year rate of major adverse cardiac events (MACE), defined as a composite of all-cause death, recurrent myocardial infarction, or ischemia-driven target vessel revascularization. At 1 year, MACE occurred in 8.3% of patients in the complete revascularization group compared to 16.7% in the culprit-only group (p = 0.04). This difference was driven by a significant reduction in the rate of subsequent ischemia-driven revascularization (3.3% vs. 10.8%, p = 0.02), whereas rates of all-cause mortality (3.3% vs. 4.2%, p = 0.73) and recurrent MI (1.7% vs. 1.7%, p = 1.00) were similar. In STEMI patients with multivessel disease, complete staged revascularization significantly reduces the 1-year risk of MACE compared to a culprit-only approach.
Keywords: ST-segment elevation myocardial infarction, Multivessel coronary artery disease, Percutaneous coronary intervention, Complete revascularization, Culprit lesion, Major adverse cardiac events
Received: January 08, 2012; Revised: February 22, 2012; Accepted: March 15, 2012; Published: April 24, 2017