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Management of Multivessel Coronary Disease after ST Elevation Myocardial Infarction Treated by Primary Angioplasty.
RIGATTIERI, STEFANO M.D., PH.D. 1; BIONDI-ZOCCAI, GIUSEPPE M.D. 2; SILVESTRI, PASQUALE M.D. 1; DI RUSSO, CRISTIAN M.D. 1; MUSTO, CARMINE M.D. 1; FERRAIUOLO, GIUSEPPE M.D. 3; LOSCHIAVO, PAOLO M.D. 1
[Miscellaneous Article] Journal of Interventional Cardiology. 21(1):1-7, February 2008.

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Background: Optimal treatment strategy of patients with ST elevation myocardial infarction (STEMI) and multivessel coronary artery disease (CAD) undergoing primary angioplasty is still unclear. Percutaneous coronary intervention (PCI) of non-culprit vessels simultaneously or soon after primary angioplasty is feasible and safe, but available data failed to consistently show a benefit in long-term clinical outcomes.

Methods: We retrospectively compared in-hospital and long-term outcomes for patients with STEMI and multivessel CAD treated by primary angioplasty with (Group 1, n=64) or without (Group 2, n=46) early, staged PCI of other angiographically significant coronary lesions. In-hospital major adverse cardiovascular events (MACE) were defined as a composite of death, periprocedural myocardial infarction after staged, elective PCI, stroke, stent thrombosis, major bleeding, and vascular complications. MACE at follow-up were defined as a composite of death, stroke, stent thrombosis, any coronary revascularization, and re-hospitalization for acute coronary syndrome.

Results: Group 1 patients underwent staged PCI 5.9 /- 3.5 days after primary angioplasty. The mean length of follow-up was 13 months (392 /- 236 days). The incidence of in-hospital MACE was 20.3% in Group 1 and 10.8% in Group 2 (P=0.186); the incidence of out of hospital MACE was 9.3% in Group 1 and 23.9% in Group 2 (P=0.037). In Group 1 in-hospital MACE were driven by periprocedural myocardial infarction after the elective procedure, which occurred in 15.6% of patients.

Conclusions: Our data show that multivessel, staged PCI in STEMI patients is associated with a low incidence of adverse events at follow-up but with a higher incidence of in-hospital MACE, mainly driven by periprocedural myocardial infarction during the elective procedure.