Short-term outcomes of complete coronary revascularization compared to staged revascularization during primary percutaneous coronary intervention in patients with multivessel coronary artery disease: Presenting with ST segment elevation myocardial infarction

Author(s): Islam Alsayed Alnashar, Ahmed Mohamed Almissiri, Ramez Raouf Guindy, Mohamed Zahran

Background: Complete revascularization has been recently popularized for management of ST-Segment–Elevation Myocardial Infarction (STEMI) patients with multivessel disease scheduled for Primary Percutaneous Coronary Intervention (PPCI). We assessed the three months outcomes of Compete Revascularization (CR) compared to staged revascularization in patients with multivessel disease undergoing PPCI.

Materials and methods: We conducted a randomized, open-label, comparative trial on STEMI patients with multivessel disease indicated for PPCI in the setting of STEMI. Patients were randomly assigned to undergo PCI revascularization of the non-culprit lesions during the index procedure, Complete Revascularization (CR) or within 30 days later after discharge, Staged Revascularization (SR). The primary endpoint was the composite of all-cause mortality, re-infarction, Heart Failure (HF), recurrence of angina symptoms, cerebrovascular stroke, and need for revascularization.

Results: A total of 100 patients were randomized in 1:1 ratio. The primary end point occurred in 24% of the patients in CR and 20% in SR group (p=0.62). The incidence of HF (14% vs. 12%; p=0.76), repeated revascularization (4% in each group), persistent angina (8% vs. 2%, p=0.16), all-cause mortality (2% in each group), MI (4% in each group), stent thrombosis (0% vs. 4%; p=0.15), and cerebrovascular accident (0% vs. 2%; p=0.32).

Conclusion: Staged revascularization provided comparable short-term benefits to complete revascularization in STEMI patients with multivessel disease undergoing PPCI. The present trial demonstrated that complete revascularization was associated with a trend towards higher incidence of stent thrombosis and CVA than staged