Author + information
- Marwan Saad1,
- Ahmed Rashed2,
- Mohamed A. El-Haddad3,
- Wael El-Kilany4,
- Bassem Wadee4 and
- Ahmed Nassar4
Revascularization of culprit vessel is the goal of primary percutaneous coronary intervention (PCI) in patients with acute ST elevation myocardial infarction (STEMI) and multivessel disease (MVD) without hemodynamic compromise. Although concurrent revascularization of significant non-culprit lesions during index procedure may reduce infarct size and health care costs; however its safety and feasibility is still debatable. We compare short and long term outcome of Staged versus Multivessel primary PCI in hemodynamically stable STEMI patients with MVD.
A single-center, open label, randomized prospective study including 50 patients with acute STEMI and one or more significant non-culprit lesions of either type A or B (high peri-procedural revascularization success rate). Patients were randomized to either culprit lesion PCI during index procedure followed by PCI to other significant lesions in a later session within 60 days (Staged revascularization group, SR) or multi-vessel revascularization during index procedure (MVR). Primary outcomes were composite of death, MI requiring hospitalization (excluding periprocedural MI), target or non-target vessel revascularization (PCI or coronary artery bypass grafting), and decreased renal function 3-5 days following administration of radiographic contrast dye. Patients were followed over a period of 12 months.
Both groups were balanced as regards baseline clinical and angiographic criteria. No significant difference between both groups in number of lesions treated (p=0.718) or number of stents used (p=0.908). Fluoroscopy time was longer in MVR (p<0.001). Similarly, amount of contrast used was higher in MVR group (p=0.011). Similar rates of major adverse cardiac events at one year were observed in both groups (22.8% and 25% in MVR and SR group respectively, p=0.428). Target vessel revascularization was also similar (9.1% in MVR and 8.3% in SR group, p=0.927). In spite of increased amount of contrast used in MVR group, there was no significant decrease in kidney function after 3-5 days compared to SR group (p=0.729).
We may conclude from this pilot study that multivessel intervention during primary PCI is feasible and safe compared to a staged PCI approach when non-culprit lesions have high rate of peri-procedural success. To our knowledge, this is the first pilot trial in literature that suggest using lesion criteria and rate of peri-procedural success to decide about the appropriate approach during primary PCI for patients with acute STEMI and MVD.