Background: In ~50-70% of patients with ST segment elevation myocardial infarction (STEMI) there is significant atherosclerotic disease in other coronary arteries in addition to the culprit vessel. A central question is what is the prognosis of STEMI patients with multi-vessel disease (MVD) who had undergone culprit-vessel primary percutaneous coronary intervention (PPCI) and subsequent non-invasive testing did not detect significant ischemia. We sought to compare the prognosis of these patients with patients having single-vessel disease (SVD).
Methods: We used our registry of patients undergoing PPCI for STEMI. The primary end point was major adverse cardiac events (MACE) and its components; all-cause mortality, re-infarction, CABG, and target vessel revascularization (TVR) within 3 years following PPCI (excluding the first 30 days after the index PCI). Patients with cardiogenic shock were excluded.
Results: The study included 721 patients with SVD and 182 patients with MVD who had undergone culprit only PPCI and had subsequent non-invasive stress testing without significant ischemia. Patients with MVD were older, (62±12 vs. 57±10 years, p=0.019), more likely to have hypertension and previous MI and less likely to be smokers than patients with SVD. A higher proportion of patients with SVD presented with anterior MI compared with patients with MVD (53% vs. 40%, p=0.005). Neither Killip class nor left ventricular function was significantly different between the groups. MACE rates were similar between the groups (18% vs. 17%, Log-Rank p=0.48). On multivariate cox regression number of diseased vessels did not emerge as an independent predictor for MACE (HR 0.84, 95%CI 0.57-1.25, p=0.39). Mortality did not differ between the groups (4% in MVD vs. 5% in the SVD group, Log-Rank p=0.43).
Conclusions: Patients with STEMI and MVD treated with PCI of the culprit artery without significant residual ischemia on non-invasive stress testing appear to have similar prognosis to STEMI patients with SVD.
