Revascularization Strategies Compared for Patients With STEMI and Multivessel Disease

January 13, 2017—Revascularization strategies for patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease were evaluated in a study published by M. Bilal Iqbal, MD, et al in Journal of the American College of Cardiology (JACC): Cardiovascular Interventions (2017;10:11–23). The investigators conducted a stratified analysis in high-risk patient groups and anatomic subsets of nonculprit disease to compare culprit vessel versus multivessel versus in-hospital staged intervention for patients with STEMI and multivessel disease.

The study sought to determine whether multivessel intervention (MVI), culprit vessel intervention (CVI) only (CVI-O), or CVI with staged revascularization (CVI-S) is associated with improved outcomes in patients with STEMI and multivessel disease. The researchers also evaluated whether MVI at primary percutaneous coronary intervention may benefit specific patient groups.

As summarized in JACC: Cardiovascular Interventions, the investigator compared revascularization strategies (MVI, CVI-O, and CVI-S) in 6,503 patients with STEMI and multivessel disease enrolled in the British Columbia Cardiac Registry (2008 to 2014). They evaluated all-cause mortality and repeat revascularization at 2 years.

The investigators reported:

• Compared with MVI, CVI-O and CVI-S were associated with lower mortality.
• Compared with CVI-O, CVI-S was associated with lower mortality.
• Compared with MVI, CVI-O was associated with increased repeat revascularization.
• Compared with CVI-O, CVI-S was associated with lower repeat revascularization. 

In addition, CVI was associated with lower mortality in the presence of nonculprit left circumflex artery disease and right coronary artery disease, but not in the presence of nonculprit left anterior descending artery disease.

The investigators concluded that in patients with STEMI undergoing primary percutaneous coronary intervention, a strategy of CVI-S seems to be associated with lower mortality and repeat revascularization rates. However, MVI may be considered in selected patients and in the setting of nonculprit left anterior descending artery disease. These findings warrant prospective evaluation in large adequately powered randomized controlled trials, advised the investigators in JACC: Cardiovascular Interventions.