SPC365

Complete revascularization vs culprit-only PCI in STEMI patients with multivessel disease: a long-term follow-up analysis (8 years) of reinfarction and all-cause mortality

Session: Comunicações Orais - Sessão 11 - Síndromes Coronárias Agudas
Speaker: André Filipe Macedo Alexandre

Congress: CPC 2023
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 13. Acute Coronary Syndromes
Subtheme: 13.7 Acute Coronary Syndromes - Other
Session Type: Comunicações Orais
FP Number: ---
Authors: André Alexandre; David Sá-Couto; André Luz; João Faria; Andreia Campinas; Anaisa Pereira; Mariana Santos; Raquel Santos; Bruno Brochado; João Silveira; Severo Torres

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Introduction</span></span></u><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">: For STEMI patients with multivessel coronary artery disease, the optimal treatment of the non-culprit artery has been controversial. Most randomised studies show that complete revascularization is associated with a reduction in the incidence of reinfarction when compared to a culprit-only percutaneous coronary intervention (PCI) strategy. However, overall effects on long-term all-cause mortality are still unclear.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Aim</span></span></u><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">: To determine whether complete percutaneous revascularization has a positive impact on long-term reinfarction and all-cause mortality in STEMI patients with multivessel disease when compared to culprit-only PCI.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Methods</span></span></u><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">: This is a retrospective study of STEMI patients admitted to primary PCI between Jan 2008 to Dec 2013 and followed for 8 year-interval. Patients with multivessel coronary artery disease were classified according to the revascularization strategy in two groups: complete percutaneous revascularization vs culprit-only PCI. The primary endpoint was all-cause mortality. The secondary endpoints were reinfarction and target vessel failure (TVF).</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Results</span></span></u><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">: From a total of 584 STEMI patients, 302 had multivessel disease and were included in the analysis: 49.7% (n=150) had 2-vessel disease; 50.3% (n=152) had 3-vessel disease. Mean follow-up time was 6.95 (&plusmn;2.29) years. 74% were male; median age was 63 years. Patients with multivessel disease were classified according to the revascularization strategy: 104 (34%) patients underwent complete percutaneous revascularization vs 198 (66%) patients who underwent culprit-only PCI. There were no significant differences between groups regarding baseline clinical characteristics, except for age (patients in the complete revascularization group were younger: 60 vs 66 years; p&lt;0.001) and smoking (more common in the complete revascularization group: 60% vs 42%; p=0.003). Regarding angiographic characteristics, there were no differences between groups, except for no-reflow (more common in the culprit-only PCI group: 7% vs 1%; p=0.020) and drug-eluted stents (more common in the complete revascularization group (69% vs 47%; p=0.001). Multivariate analysis with Cox regression revealed that culprit-only PCI was independently associated with a higher risk of reinfarction (adjusted HR 2.46; 95% CI 1.12-5.38; p=0.025) and TVF (adjusted HR 2.37; 95% CI 1.02-5.48; p=0.044) when compared to complete percutaneous revascularization, but with no significant differences in the primary endpoint of all-cause mortality (adjusted HR 1.37; 95% CI 0.64-2.93; p=0.421).</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Conclusion</span></span></u><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">: Our study corroborates the benefits of complete revascularisation for STEMI patients with multivessel disease with regard to the incidence of reinfarction, while demonstrating the lack of effect on all-cause mortality at long-term follow-up.</span></span></span></span></p>