The specification of revascularization strategy in patients with ST-elevation myocardial infarction and multi-vessel disease

Aim: to compare the outcomes of the basic strategies of endovascular treatment of patients with ST-elevation myocardial infarction (STEMI) and multi-vessel (MV) disease. We performed a retrospective analysis of primary percutaneous coronary intervention (PCI) long-term outcomes in a sample of 74 consecutive STEMI patients with MV disease. Patients were divided into the following groups: 1 - infarct-related artery (IRA) PCI only, followed by medical therapy; 2 - MV stenting in primary PCI; 3 - staged PCI patients. The long-term outcomes were analyzed. The endpoints were death, MI, repeat revascularization (TVR and non-TVR), stent-thrombosis. Composite endpoint (death+MI+revascularization) rate were 62,17 and 4.5% in «PCI IRA», «MV stenting» and «staged PCI» group, respectively. TVR+non-TVR rate made up 34.5,13 and 4.5% in «PCI IRA», «MV stenting» and «staged PCI» group. «IRA stenting» strategy in our clinical practice is associated with severity of coronary artery disease, 10.3% of mortality, 20.7% of stent-thrombosis and 62% of the combined endpoint in 10.9±7.8 moths. The «MV stenting» strategy in PCI showed comparable long-term outcomes with a «staged PCI» group in patients with moderate severity of coronary artery disease. Both «MV stenting» and «staged PCI» strategy in our study demonstrate advantages compared with only «IRA stenting», as the frequency of the Gomposite endpoint, and TVR+non-TVR.