Long-Term Outcomes of Staged Non-Culprit Lesions Percutaneous Coronary Intervention for Multivessel Disease in Patients Presenting with ST-segment Elevation Myocardial Infarction

Background and Objectives:
Multivessel coronary artery disease (MVD) is frequently (40-60%) encountered in patients with ST elevation myocardial infarction (STEMI) and it has been associated with worse clinical course.
Long-term outcomes of percutaneous coronary interventional (PCI) strategy for dealing with significant non-culprit lesion in patients with multi-vessel disease after STEMI are conflicting and optimal timing of non-culprit lesion revascularization is not well investigated.
This study aimed to determine outcomes of staged complete multivessel PCI (MV-PCI) in patients with STEMI compared with culprit only PCI.

Methods:
This study was a retrospective analysis of the patients with STEMI and MVD, treated by primary percutaneous coronary intervention (PPCI), follow-up was one year after admission with STEMI.
Patients were divided into 2 groups: group of patients who completed the staged PCI for the non-infarct related artery (with sub analysis of timing staged PCI) and culprit only revascularization group.
We performed analysis of both groups for MACE: mortality (cardiac and non-cardiac), recurrence of hospitalization due to cardiovascular causes, incidence of repeat revascularization or the need for coronary artery bypass graft (CABG) procedure during a year follow up after STEMI.

Results:
Staged non-culprit lesions PCI was planned in 92 patients, staged complete multivessel PCI was performed in 56 patients (60%).
Complete staged revascularization was associated with a lower rate of repeat revascularization (9% vs 36%, p=0.002) and need for re-hospitalization (13% reduction, p<0.002).
There were no significant difference in the mortality rate between the 2 groups.

Conclusions:
Staged complete multivessel PCI was safe and prevented recurrent hospitalization and unplanned repeat revascularization during 1 year follow-up in patients presenting with STEMI and MVD.