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Optimizing Complete Revascularization Strategy in STEMI: Insights from a Real-world Single-Center Analysis
Session:
Comunicações Orais - Sessão 09 - Síndrome coronária aguda 1
Speaker:
Catarina Oliveira
Congress:
CPC 2024
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:
Comunicações Orais
FP Number:
---
Authors:
Catarina Simões De Oliveira; Ana Margarida Martins; Ana Beatriz Garcia; Miguel Raposo; Ana Abrantes; Sofia Esteves; Inês Araújo; Cláudia Jorge; Miguel Nobre Menezes; João Silva Marques; Pedro Pinto Cardoso; Fausto J.Pinto
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction</strong>: Complete revascularization in ST-segment elevation myocardial infarction (STEMI) improves outcomes. However, the optimal timing of non-culprit lesions revascularizing remains undefined. The recent MULTISTARS trial reported better outcomes for immediate complete revascularization in the index procedure compared to non-culprit-deferred treatment.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Aim</strong>: As MULTISATRS strategy does not reflect our current practice we sought to describe and compare the results of our early non-culprit deferred revascularization strategy with those reported in the trial.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Methods</strong>: Single-center observational study of consecutive patients (pts) with STEMI and multivessel disease in whom a staged procedure aiming complete revascularization was done between 2014 and 2022. Patients presenting in cardiogenic shock and those with non-culprit chronic total occlusions or stent restenosis were excluded. Primary endpoint was defined as a composite of death from any cause, nonfatal MI, unplanned ischemia-driven revascularization, and hospitalization for heart failure (HF) at one year and was prospectively assessed in pts that underwent angioplasty of a non-culprit lesion in the deferred procedure. </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Results</strong>: A total of 345 pts met inclusion criteria. The characteristics of the pts (<strong>Table I</strong>) did not significantly differ from those included in the MULTISTARS trial. The majority presented with inferior (48%) or anterior (42.6%) STEMI. Almost one third of the patients had more than one non-culprit severe lesions (27.8%). Median time to deferred procedure was 5 days vs 37 days in the MULTISTARS trial. Most pts (94.2%) received complete revascularization during the index hospitalization (median length of stay 7 days). In the deferred procedure, the non-culprit lesion was not treated in 11% of the pts after angiographic (n=21) or functional (n=28) assessment. </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">The primary endpoint occurred in 7.5% of our staged early revascularization group, compared with 8.5% in the MULTISTARS immediate group and 16.3% in the staged group (<strong>Figure 1</strong>). Regarding the individual components of the primary endpoint, nonfatal MI in our population (1.3%) was similar to the immediate revascularization group (2%) and inferior to the staged group (5.3%), while unplanned ischemia-driven revascularization was lower compared to the two MULTISTARS groups (immediate 4.1% vs staged 9.3%).</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion</strong>: The results of our staged early revascularization group were comparable to the immediate revascularization arm of the MULTISTARS trial. Until we have randomized data, our results are reassuring that an early staged complete revascularization strategy in STEMI may be safe and effective. Additionally, this strategy may avoid 10% of unnecessary interventions.</span></span></p>
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