SPC365

Multivessel disease in ST- elevation myocardial infarction: what is the best timing for complete revascularization?

Session: Posters - E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Speaker: Carla Marques Pires

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: Carla Marques Pires; João Costa; Rui Ferreira; Carlos Galvão Braga; Pedro Costa Ferreira; Marco Costa; Rui Campante Teles; Luís Brizida; Hélder Pereira; Luís Bernardes; José Baptista; Francisco Pereira Machado; Pedro Pinto Cardoso; João Carlos Silva; em Nome Dos Investigadores do Registo Nacional de Cardiologia de Intervenção.

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>INTRODUCTION: </strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Multivessel disease occurs in approximately 50% of patients with ST-elevation myocardial infarction (STEMI). The current European guidelines recommend routine revascularization of non infarct-related artery during hospitalization (IIaA), although&nbsp; the optimal timing of non-culprit revascularization remains controversial. </span></span></p>

<p style="text-align:justify">&nbsp;</p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>AIMS: </strong>To assess the clinical differences and prognosis impact of complete revascularization (CR) during hospitalization or until 2 months after hospital discharge in STEMI patients with multivessel disease.</span></span></p>

<p style="text-align:justify">&nbsp;</p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>METHODS: </strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">We performed a multicentric retrospective observational cohort study including patients with STEMI and multivessel disease without cardiogenic shock at admission over a 12-year period with 1-year follow-up. </span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Patients without CR during hospitalization or until 2 months after hospital discharge were excluded.</span></span></p>

<p style="text-align:justify">&nbsp;</p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>RESULTS:</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">This study evaluated 20873 patients with STEMI and multivessel disease, of whom just 12.2% underwent complete revascularization.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">After applying exclusion criteria, we analysed 1782 patients with a mean age of 63 years and 75% of male gender.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Then we divided 93.8% to Group 1 (G1), patients with CR during hospitalization, and 6.2% to Group 2 (G2), patients with CR until 2 months after hospital discharge .</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">G1 had a higher prevalence of female gender (p=0.031) and a lower prevalence of some cardiovascular (Cv) risk factors, as dyslipidemia (p&lt;0.001), smoking habits (p&lt;0.001) and <em>Mellitus</em> diabetes (p=0.002). G2 more frequently presented with LVEF&le;40% (p=0.018), were more likely to have complex coronary lesions (C-type lesions) (p&lt;0.001), to do thrombectomy (p&lt;0.001) and Glycoprotein IIb/IIIa inhibitors (p&lt;0.001) during percutaneous coronary intervention (PCI), to have post-PCI renal failure (p&lt;0.001) and&nbsp; periprocedural complications (p&lt;0.001).</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">In this study the timing for CR wasn&rsquo;t a predictor of in-hospital primary (composite of death, MI and stroke) and secondary (composite of death, MI, stroke and major bleeding) endpoint in univariate and multivariate analysis.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Additionally, during 12-months follow-up, there was no difference between groups regarding death or follow-up primary endpoint (death, stroke, MI and angina at least II in CCS) in univariate and multivariate analysis.</span></span></p>

<p style="text-align:justify">&nbsp;</p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>CONCLUSION</strong>: </span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Despite current knowledge supports complete revascularization in patients with STEMI and multivessel disease, our cohort revealed a low prevalence of CR (12.2%) irrespective of the timing of non-culprit lesion intervention.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">In our study we realized that the timing for CR had no impact on in-hospital and follow-up outcomes. However, is noteworthy to highlight that patients undergoing CR during hospitalization had lower prevalence of Cv risk factors, higher LVEF and less complex and uncomplicated PCI. </span></span></p>