Management of Multivessel Coronary Disease after ST Elevation Myocardial Infarction Treated by Primary Angioplasty

Abstract

Our data show that multivessel, staged PCI in STEMI patients is associated with a low incidence of adverse events at follow-up but with a higher incidence of in-hospital MACE, mainly driven by periprocedural myocardial infarction during the elective procedure.

2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction

“…These variations have contributed to the disparate findings reported, although there seems to be a clear trend toward lower rates of adverse outcomes when primary PCI is limited to the infarct artery and PCI of a noninfarct artery is undertaken in staged fashion at a later time. 216,224,225,383,384 The largest of these observational studies compared 538 patients undergoing staged multivessel PCI within 60 days of primary PCI with propensity-matched individuals who had culprit-vessel PCI alone. 216 Multivessel PCI was associated with a lower mortality rate at 1 year (1.3% versus 3.3%; P=0.04).…”

Benefit of Revascularization in Non-Infarct-Related Artery in Multivessel Disease Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

“…16,17,20,21) Some studies have suggested that complete revascularization during primary PCI has a positive impact on the clinical outcome. 17,20) In contrast, other studies have shown that one-stage primary PCI for IRA and non-IRA not only provide no additional therapeutic benefit, but also increased the incidence of adverse clinical outcomes.…”

“…8) While some reports have claimed an improved short-term clinical outcome from complete revascularization during primary PCI, 17,20) other studies found that the potential harm actually outweighed the benefits for simultaneous PCI to non-IRA during primary PCI. 16,21) In the current study, the prognostic outcomes of patients with single-vessel disease (SVD) and those with MVD were compared. Moreover, based on the above issues, 8,11,12) this study investigated the benefits of staged complete revascularization in reducing future cardiac events and improving the clinical outcome of patients with STsegment elevation myocardial infarction (STEMI) associated with MVD after primary PCI.…”

Single or multivessel percutaneous coronary intervention in ST‐elevation myocardial infarction patients

“…The actual risk/benefit ratio of a MV percutaneous intervention in STEMI patients during the first hospital stay is unclear especially if one considers the technological and pharmacological adjuncts presently available. Literature reports give conflicting results [3][4][5][6][7][8][9][10] and sufficiently powered randomized clinical trials are lacking [11,12].…”