Author + information
- Joshua P. Loh,
- Hironori Kitabata,
- Lakshmana K. Pendyala,
- Israel M. Barbash,
- Danny Dvir,
- Sa'ar Minha,
- Salem M. Badr,
- Rebecca Torguson,
- Lowell F. Satler,
- Kenneth M. Kent,
- William O. Suddath,
- Augusto D. Pichard and
- Ron Waksman
In patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease undergoing primary percutaneous coronary intervention (PCI), staged non-culprit vessel PCI at a separate session is recommended. It is not known whether performing staged PCI within the same hospitalization as the primary PCI is safe.
We analyzed 282 consecutive STEMI patients with multivessel disease who underwent primary PCI followed by staged PCI of the non-culprit vessel. Patients were categorized into staged PCI in the same hospitalization (n=184) and staged PCI at a separate hospitalization within 8 weeks of primary PCI (n=98). In-hospital outcomes and procedural complications after staged PCI were analyzed.
Baseline characteristics, STEMI presentation and procedure characteristics were similar in both groups. Contrast amount used was higher in the separate versus same hospitalization group for both index (175 vs. 153ml, p=0.011) and staged (144 vs. 120ml, p=0.004) PCI. More left main PCI occurred in the separate hospitalization group during the staged PCI (3.9 vs. 0.3%, p=0.008). Angiographic success of staged PCI was similar in same versus separate hospitalization, with similar rates of vascular complications and major bleeding, but a trend toward higher incidence of acute renal failure. Following staged PCI, in-hospital major adverse cardiac events (3.3 vs. 1.0%, p=0.43) and mortality (2.7 vs. 0%, p=0.17) were similar in both groups.
It is safe to perform staged PCI within the same hospitalization as primary PCI, achieving similar procedural success and in-hospital outcomes as staged PCI at a separate hospitalization. Higher contrast volume used during primary PCI and the presence of left main lesion in non-culprit vessels may influence the decision to stage the PCI at a separate hospitalization.
|In-hospital outcomes following staged percutaneous coronary intervention|
|Staged PCI in the same hospitalization (n=184)||Staged PCI at a separate hospitalization (n=98)||P value|
|Major adverse cardiac events||6 (3.3%)||1 (1.0%)||0.43|
|Death||5 (2.7%)||0 (0%)||0.17|
|Urgent coronary artery bypass graft||1 (0.5%)||1 (1.0%)||1.00|
|Procedure-related acute renal failure||7 (3.8%)||1 (1.0%)||0.27|
|Vascular complications||6 (3.3%)||3 (3.1%)||1.00|
|Major bleeding||3 (1.6%)||2 (2.0%)||1.00|
- 2013 American College of Cardiology Foundation