A Risk Score Based on Angiographic Characteristics to aid Choosing the Optimal Revascularization Strategy for Patients with Multivessel Disease Presenting with ST Elevation Myocardial Infarction

Background: The optimal revascularization strategy is not clearly defined for patients with ST elevation myocardial infarction with multivessel disease (MV-STEMI). We aimed to develop a simple angiographic risk score for identifying patients with MV-STEMI that might benefit from a multivessel percutaneous coronary intervention (MV-PCI), compared to a PCI for only the infarct-related artery (IRA-PCI).

Methods and Results: This retrospective study acquired data from a single-center STEMI registry on 841 consecutive patients with MV-STEMI (645 IRA-PCI, 196 MV-PCI). Patients were stratified according to high- and low-risk scores. We devised a score based on three characteristics of non-culprit lesions previously reported to predict overall mortality (proximal left anterior descending artery involvement, maximal % stenosis, and number of involved vessels). The primary endpoint was major adverse cardiac events (MACE: a composite of death/MI/urgent repeat revascularization). After a median follow up of 1909 days, MACE occurred in 205/841 (24.4%) patients. MACE risk was higher in the high-risk than in the low-risk group (HR 1.52, p= 0.003). In comparing the IRA-PCI and MV-PCI approaches within each risk group, we found that these revascularization strategies had differential effects on outcome. Compared to the MV-PCI, the IRA-PCI was associated with improved results in the low-risk group (HR 0.597, p=0.033), but worse results in the high-risk group (HR 3.14, p<0.001).

Conclusions: For patients with MV-STEMI that undergo primary PCI, a simple risk score based on three angiographic characteristics could identify patients at high risk of future adverse events. This score might facilitate choosing the optimal revascularization strategy.