PURPOSE: To compare long-term outcomes of complete revascularization versus culprit only revascularization in primary percutaneous coronary intervention (PCI).
METHODS: Prospective observational study of 151 consecutive patients with acute percutaneous intervention (STEMI) that underwent primary PCI and showed multivessel coronary stenosis. Thirty eight patients (25%) underwent complete revascularization (CR): the culprit artery was opened first followed by dilatation of the other significantly narrowed arteries. One hundred and thirteen patients (75%) had culprit only revascularization (COR) during the primary PCI. Patients were followed-up for 1-year.
RESULTS: The only significant difference in baseline characteristics was infarction location. CR patients tended to have less frequently anterior wall infarction and more frequently postero-lateral infarction. CR tended to be associated with reduced incidence of major cardiac events: no in-hospital mortality versus 8.8% in COR patients (p=0.058); 8.3% all-cause 1-year mortality versus 10.5% in COR group (p=n.s); 2.7% PCI during follow-up versus 18.5% in COR group (p<0.05) and 2.6% acute heart failure during the follow-up versus 8.8% in COR patients (p=n.s.).
CONCLUSION: Multivessel PCI during acute myocardial infarction is feasible and safe. Complete revascularization appears to be associated with at least as successful in-hospital and long-term outcomes as COR. This data support a policy of complete revascularization during primary PCI for STEMI.
CLINICAL IMPLICATIONS: Currently it is recommended to treat only the culprit artery during primary PCI for acute STEMI. Only a few reports describe the results of simultaneous non-culprit vessel PCI. As a result, the long-term outcome of patients submitted to complete revascularization during primary PCI is currently unknown and presently it remains unclear if culprit-only revascularization is better than complete revascularization during PCI.
DISCLOSURE: Natalia Antonio, No Financial Disclosure Information; No Product/Research Disclosure Information