Objective In the clinical scenario of ST-segment elevation acute myocardial infarction,
several patients with multivessel coronary atherosclerotic disease are discharged
without a defined strategy to monitor the residual atherosclerotic lesions. The
clinical endpoints evaluated were cardiovascular death, symptoms of angina
pectoris, rehospitalization for a new acute coronary syndrome, and the necessity
of reintervention during the two-year follow-up. MethodsThis observational, prospective, and historical study included multivessel
coronary atherosclerotic disease patients who were admitted to a tertiary care
university hospital with ST-segment elevation acute myocardial infarction and
underwent primary percutaneous coronary intervention with stent implantation only
at the culprit lesion site; these patients were monitored in the outpatient clinic
according to two treatments: the Clinical Group - CG (optimized pharmacological
therapy associated with counseling for a healthy diet and cardiac rehabilitation)
or the Intervention Group - IG (new staged percutaneous coronary intervention or
surgical coronary artery bypass graft surgery combined with the previously
prescribed treatment). Results Of 143 patients consecutively admitted with ST-segment elevation acute myocardial
infarction, 57 were eligible for the study (CG=44 and IG=13). Regarding the
clinical endpoints, the cardiovascular death rate did not differ between the CG
and IG. The symptom of angina pectoris and the rehospitalization rate for a new
episode of acute coronary syndrome were accentuated in the CG
(P=0.020 and P=0.049, respectively) mainly in
individuals with evidence of ischemia evidenced by myocardial scintigraphy
(P<0.001 and P=0.001, respectively) which
culminated in an even greater need for reintervention (P=0.001)
in this subgroup of patients. Conclusion The staged intervention was demonstrated to be safe and able to reduce angina
pectoris and rehospitalization for a new episode of acute coronary syndrome. In
addition, it decreases the likelihood of unplanned reinterventions of patients
without ischemia evidenced by myocardial scintigraphy.