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Staged intervention may benefit patients with STEMI undergoing PCI
Culprit vessel intervention with staged revascularization may be the optimal primary PCI strategy for some patients with STEMI, according to new findings.
Researchers analyzed 6,503 patients with STEMI and multivessel disease enrolled in the British Columbia Cardiac Registry who underwent PCI between 2008 and 2014.
M. Bilal Iqbal, MD, PhD, and colleagues compared 2-year all-cause mortality and repeat revascularization between patients who underwent one of three PCI strategies: multivessel intervention, culprit vessel intervention only or culprit vessel intervention with staged revascularization.
Iqbal, from the Victoria Heart Institute Foundation and Royal Jubilee Hospital, British Columbia, Canada, and colleagues found that compared with multivessel intervention, culprit vessel-only intervention (HR = 0.78; 95% CI, 0.64-0.97) and culprit vessel intervention with staged revascularization (HR = 0.55; 95% CI, 0.36-0.82) were associated with lower mortality at 2 years.
In addition, culprit vessel intervention with staged revascularization was associated with lower mortality compared with culprit vessel-only intervention (HR = 0.65; 95% CI, 0.47-0.91).
Culprit vessel-only intervention was linked to more frequent repeat revascularization at 2 years than multivessel intervention (HR = 1.25; 95% CI, 1.02-1.54) and culprit vessel intervention with staged revascularization was associated with less frequent repeat revascularization than culprit vessel-only intervention (HR = 0.64; 95% CI, 0.46-0.9), according to the researchers.
Compared with multivessel intervention, any type of culprit intervention was associated with lower 2-year mortality in patients with nonculprit left circumflex artery disease (HR = 0.63; 95% CI, 0.45-0.89) and right CAD (HR = 0.66; 95% CI, 0.44-0.99) but not in those with nonculprit left anterior descending artery disease (HR = 0.83; 95% CI, 0.54-1.28), Iqbal and colleagues wrote.
“Subgroup analyses identified that [culprit vessel intervention] at the index intervention was specifically associated with greater survival in patients [older than] 60 years, diabetes, renal disease, liver/gastrointestinal disease, not requiring [intra-aortic balloon pump] therapy and not undergoing rescue PCI,” they wrote.
In a related editorial, Merril L. Knudtson, CM, MD, from the University of Calgary, Faculty of Medicine, Alberta, Canada, wrote that “clinical research in this area has been hampered by inconsistent lesion severity thresholds” and other factors, and that “nonculprit disease discovered in the setting of acute STEMI intervention requires a plan that acknowledges the need to avoid reflex supplemental intervention at this vulnerable time.” – by Erik Swain
Disclosure: The researchers and Knutson report no relevant financial disclosures.