SPC365

Complete revascularization in STEMI with multivessel disease: how late is too late?

Session: Posters - E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Speaker: Joana Silva Ferreira

Congress: CPC 2021
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 13. Acute Coronary Syndromes
Subtheme: 13.4 Acute Coronary Syndromes – Treatment
Session Type: Posters
FP Number: ---
Authors: Joana Silva Ferreira; Marta Ferreira Fonseca; Cátia Costa; José Maria Farinha; Ana Fátima Esteves; António Pinheiro Candjondjo; Rui Coelho; Rui Caria
<div style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:11.0pt"><span style="background-color:white"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black">Background</span></span></span></span></strong><span style="font-size:11.0pt"><span style="background-color:white"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black">: Recent research has shown that in patients (pts) with ST-elevation myocardial infarction (STEMI) and multivessel coronary disease, revascularization of non-culprit lesions soon after primary percutaneous coronary intervention (PCI) reduces the risk of death and myocardial infarction (MI) compared with culprit-lesion-only PCI. </span></span></span></span><span style="font-size:11.0pt"><span style="background-color:white"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black">However, in real-world practice, centres often cannot perform PCI of non-culprit lesions as early after hospital discharge as reported in these studies.&nbsp;</span></span></span></span></span></span></div>

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<span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:11.0pt"><span style="background-color:white"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black">Purpose</span></span></span></span></strong><span style="font-size:11.0pt"><span style="background-color:white"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black">: To analyse current treatment of STEMI with multivessel disease in a district hospital and determine if there is still benefit in doing complete revascularization (CR) even when non-culprit lesion PCI is done late after hospital discharge.</span></span></span></span></span></span></div>

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<div style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:11.0pt"><span style="background-color:white"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black">Methods</span></span></span></span></strong><span style="font-size:11.0pt"><span style="background-color:white"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black">: We conducted a retrospective pilot study including all consecutive pts with STEMI submitted to primary PCI in a district hospital in 2018 who presented angiographically significant multivessel disease (&ge; 1 non-culprit lesion with &ge; 70% stenosis) amenable to PCI. We compared outcomes (death, MI, stroke and ischaemia-driven revascularization) between 3 groups: group A &ndash; pts who underwent CR after hospital discharge; group B &ndash; those who did it during index hospital stay; group C &ndash; pts who only underwent culprit-lesion PCI.&nbsp; Exclusion criteria included history of coronary bypass graft, cardiogenic shock at admission, a chronic total occlusion as single non-culprit lesion and death before treatment strategy was defined.</span></span></span></span></span></span></div>

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<div style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:11.0pt"><span style="background-color:white"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black">Results</span></span></span></span></strong><span style="font-size:11.0pt"><span style="background-color:white"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black">: Of the 302 pts treated for STEMI in 2018, 125 had multivessel disease. Of these, 27 met exclusion criteria, resulting in a sample of 98 pts with a mean age of 66 years. Median time from symptom onset to PCI was 5 hours, with 8% of pts presenting in Killip class II-III. Group A (n=15; 15%) underwent PCI of non-culprit lesions after a median of 86 days from primary PCI and group B (n=60; 61%) after a median of 3 days. Group C included 18 patients (18%). &nbsp;An additional 5 pts had non-culprit lesions&nbsp;treated surgically&nbsp;after a median of 364 days.&nbsp;</span></span></span></span></span></span></div>

<div style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:11.0pt"><span style="background-color:white"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black">At a median follow-up of 2.4 years, mortality in group A did not significantly differ from group B [A=0% (n=0)&nbsp;<em><span style="font-family:&quot;Calibri Light&quot;,sans-serif">vs</span></em> B=12% (n=7); log-rank test: p=0.185] but was significantly inferior to group C [C=29% (n=5); A&nbsp;&nbsp;<em><span style="font-family:&quot;Calibri Light&quot;,sans-serif">vs</span></em> C: p=0.037]. MI,&nbsp;stroke and a composite endpoint&nbsp;of MI, stroke and&nbsp;death did not significantly differ between groups. The secondary outcome of ischaemia-driven revascularization occurred more often in group A compared with B (HR 6.68; 95% CI 1.09-41.01; p=0.040).&nbsp;</span></span></span></span></span></span></div>

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<strong><span style="font-size:11.0pt"><span style="background-color:white"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black">Conclusions</span></span></span></span></strong><span style="font-size:11.0pt"><span style="background-color:white"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black">: This study suggests that complete revascularization in STEMI with multivessel disease even late after hospital discharge is still superior to culprit-lesion only PCI in reducing risk of death. On the other hand, this late revascularization seems to be associated with higher rates of ischaemia-induced revascularization. Further research with a larger sample will be required to confirm the results of this pilot study.</span></span></span></span></div>