Results of single-center revascularisation registry of ST-elevation myocardial infarction in patients with multivessel disease

The aim of the study was to compare the results of the underinvestigated strategy of multivessel stenting (MS) in primary percutaneous coronary intervention (PCI) with the results of the conventional strategy of staged revascularization (SR) (primary PCI followed by revascularization of nontarget vessels or coronary artery bypass grafting (CABG)) in patients with STelevation myocardial infarction (STEMI) and multivessel coronary disease (MVCD) without cardiogenic shock. The study included 163 sequential STEMI patients with MVCD treated in our center from 2009 to 2010. The inhospital (30 days) and longterm (10.6±5.9 months) results of different revascularization strategies were analyzed. The MVCD patients were divided into two groups: primary PCI group (n=30) and SR group (n=133). The study endpoints were death, myocardial infarction (MI), and repeated target vessel revascularization (TVR). The combined end point included death, MI, and TVR. The frequency of the combined end point was evaluated as well. The diagnosed stent thrombosis was examined throughout the entire period of observation according to the standard classification of Academic Research Consortium (ARC). The results in PCI and SR groups were comparable during the inhospital period. No differences in the end point frequencies were found between the groups (deaths: 6.6 vs 5.3%; IM: 0 vs. 4.5%; TVR: 0 vs 3.8% in the PCI and SR groups, respectively; p>0.05). The frequencies of the combined endpoints did not differ as well (6.6 vs 13.5% in the MS and SR groups, respectively; p>0.05). The longterm results in the primary endpoint frequencies were comparable. No differences between the results in the MS and SR cohorts were found (deaths: 6.6 vs 6%; 0 vs 8.3%; TVR: 3.3 vs 11.3%, respectively; p>0.05). The frequencies of the combined endpoints were 10 and 25.6% in the MS and SR cohorts, respectively (p>0.05). Frequencies of the stent thrombosis in MS and SR groups were 3.3 и 6%, respectively (p>0.05). Data showed significant advantages of the MS over SR strategy in regard to the total TVR and nonTVR intervention frequencies (16.6 vs 58.6%, respectivley; p=0.0001). In the present study, only 47% patients (n=63) of SR group received the secondstage CABG or PCI as planned. Current guidelines for STEMI treatment in patients with MVCD without cardiogenic shock recommend the staged approach: infarctrelated artery PCI and delayed treatment of nonculprit lesions by PCI or CABG. In real life, a significant proportion of patients do not receive the second stage of revascularization for various reasons. In our study, 70 patients (51%) of the SR cohort did not receive the second stage intervention. The MS strategy is not listed in the current recommendations for revascularization. However, in the present registry, the MS strategy showed the comparable in hospital and longterm results versus the conventional SR. Our data provided evidence for advantages of the MS over SR strategy in regard to total frequency of TVR and nonTVR in the longterm. Evidence of insignificant advantages of the MS over SR strategy in all separate main end points (death, IM, and TVR) requires further studies and, perhaps, revision of the current recommendations.