Complete revascularization with PCI in STEMI patients with multivessel disease, when is the appropriate time?

Heberto Aquino-Bruno, Department of Cardiology, Centro Médico Nacional 20 de Noviembre, ISSSTE, Mexico City, Mexico
Juan F. García-García, Department of Cardiology, Centro Médico Nacional 20 de Noviembre, ISSSTE, Mexico City, Mexico
Roberto Muratalla-González, Department of Cardiology, Centro Médico Nacional 20 de Noviembre, ISSSTE, Mexico City, Mexico
Marco A. Alcántara-Meléndez, Department of Cardiology, Centro Médico Nacional 20 de Noviembre, ISSSTE, Mexico City, Mexico
Julieta D. Morales-Portano, Department of Cardiology, Centro Médico Nacional 20 de Noviembre, ISSSTE, Mexico City, Mexico
Enrique B. Gómez-Álvarez, Department of Cardiology, Centro Médico Nacional 20 de Noviembre, ISSSTE, Mexico City, Mexico
José A. Merino-Rajme, Department of Cardiology, Centro Médico Nacional 20 de Noviembre, ISSSTE, Mexico City, Mexico
José A. Castro-Rubio, Departament of Internal Medicine, Hospital Regional de Alta Especialidad, ISSSTE, Puebla, Mexico
Juan C. Plata Corona, Department of Cardiology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico

Objective: The purpose was to compare the outcomes of patients with ST-elevation myocardial infarction and multivessel coronary artery disease undergoing one-time multivessel revascularization (OTMVR) versus in-hospital staged complete revascularization with percutaneous coronary intervention. Methods: This was a single-center, retrospective, observational, and cohort study, including data from January 2013 to April 2019. A total of 634 patients were included in the study. Comparisons were made between patients who underwent in-hospital staged complete revascularization versus OTMVR. The primary endpoint was all-cause in-hospital mortality, secondary endpoints included cardiovascular complications, all-cause new hospitalization, and mortality evaluated at 30 days and 1 year. In addition, we constructed a logistic regression model for determining the risk factors that predicted mortality. Results: Of the 634 patients, 328 were treated with staged revascularization and 306 with OTMVR. About 76.7% were men, with a mean age of 63.3 years. Less complex coronary lesions and a higher proportion of the left anterior descending artery as the culprit vessel were found in the OTMVR group. Compared with staged revascularization, the primary and secondary endpoints occurred less frequently with OTMVR strategy. Conclusions: OTMVR did not generate more complications and demonstrate better clinical outcomes than in-hospital staged revascularization.

Keywords: Acute coronary syndromes. Complete revascularization. Multivessel coronary artery disease. Percutaneous coronary intervention. ST-elevation myocardial infarction.