ISSN 2996-8215
International Journal of Cardiology | Vol. 10, No. 6, June 2019 | pp. 41–48
DOI: 10.46882/2019/IJC/000123
Original Research Article
Three-Year Clinical Outcomes of Complete Staged Revascularization versus Culprit-Only Revascularization in Older STEMI Patients with Multivessel Disease
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:
Multivessel coronary artery disease (MVD) significantly complicates management strategies during primary percutaneous coronary intervention (PPCI) for acute ST-segment elevation myocardial infarction (STEMI). While early complete revascularization reduces short-term event rates, the long-term clinical durability of this approach remains poorly characterized in geriatric populations. This prospective randomized trial compared the 3-year outcomes of complete staged revascularization versus a culprit-only strategy in elderly individuals. We randomized 220 patients aged greater than or equal to 75 years with acute STEMI and angiographic MVD into two interventional groups: complete staged revascularization (PPCI of the culprit vessel followed by staged PCI of non-culprit stenoses within 10 days, n = 110) or culprit-only revascularization (PPCI restricted to the infarct-related artery, n = 110). The primary endpoint was the 36-month cumulative 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 3 years, the primary endpoint was significantly lower in the complete revascularization group than in the culprit-only group (14.5% vs. 26.4%, hazard ratio: 0.52, 95% CI: 0.28–0.96, p = 0.03). This benefit was sustained by a substantial reduction in subsequent target vessel revascularizations (4.5% vs. 15.5%, p < 0.01). Long-term all-cause mortality did not differ significantly between the arms (8.2% vs. 9.1%, p = 0.82). Staged complete revascularization provides superior long-term clinical outcomes in elderly STEMI patients with multivessel disease, effectively reducing 3-year MACE without increasing procedural hazard profiles.
Keywords: ST-segment elevation myocardial infarction, Multivessel disease, Percutaneous coronary intervention, Complete revascularization, Geriatric cardiology
Received: March 05, 2019; Revised: April 18, 2019; Accepted: May 11, 2019; Published: June 19, 2019