Staged PCI for Complete Revascularization Compared With Culprit Vessel–Only PCI for STEMI and Multivessel CAD
May 14, 2019—Investigators conducted a study in China that compared the benefit and long-term outcomes of staged percutaneous coronary intervention (PCI) for complete revascularization versus culprit vessel–only PCI in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease.
The study's findings were published online ahead of print in The American Journal of Cardiology (AJC) by Kongyong Cui, MD, et al from Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart, Lung, and Blood Vessel Diseases in Beijing, China.
The single-center study was composed of 1,205 patients who were treated with staged PCI (n = 576) or "culprit-only" PCI (n = 629) from January 2006 to December 2015 at the investigators' institution in Beijing. After propensity score matching, 415 pairs of patients were identified, and postmatching absolute standardized differences were < 10% for all covariates. The primary endpoint was the major adverse cardiac and cerebrovascular event (MACCE) rate, defined as a composite of all-cause death, myocardial infarction (MI), stroke, or unplanned revascularization. The mean follow-up duration was 5 years.
As summarized in AJC, staged complete revascularization was associated with lower risks of MACCE, MI, unplanned revascularization, and a composite of cardiac death, MI, or stroke compared with culprit-only PCI in both the overall population and propensity-matched cohorts.
The investigators found that in the Cox proportional hazards regression analysis, the strategy of staged PCI was a consistent and significant predictor of lower incidences of MACCE, MI, unplanned revascularization, and a composite of cardiac death, MI, or stroke. However, there was no difference in the risks of MACCE and unplanned revascularization between the two approaches for diabetic patients.
The study's conclusion was that among patients with STEMI and multivessel disease who underwent primary PCI, an approach of staged complete revascularization is superior to culprit-only PCI at 5-year follow-up. Nevertheless, the advantage of staged PCI is attenuated in diabetic patients, advised the investigators in AJC.