Two year follow up of patients with STEMI and multivessel coronary disease treated with immediate versus staged coronary revascularization

In patients presenting with STEMI and multivessel coronary disease current guidelines recommend complete revascularization. However, the optimal timing of revascularization of non-IRA has not yet been estabilished and there are no recommendations yet, in favour of immediate versus staged PCI.

The aim of this study was to evaluate and compare the 2-year clinical outcomes in two groups of patients presented as multivessel STEMI and treated with percutaneous coronary angioplasty with stent placement, one of whom underwent immediate revascularization and the other staged revascularization at our university hospital center.

This is an observational, prospective, unicenter study which includes 20 patients presented as multivessel STEMI and treated with coronary angioplasty with stent placement after randomization into two groups: (1) immediate revascularization, (2) staged revascularization, in the period April-July 2022 in QSUNT. For all patients, a 2-year follow-up was performed from the moment of PCI. Primary endpoint: occurrence of a major adverse cardiovascular and cerebrovascular event (composite of death, cerebrovascular accident, nonfatal myocardial infarction, unplanned revascularization for ischemic causes, hospitalization for heart failure) at 2 years. Secondary endpoints: hemorrhage; acute renal failure; angina at 2 years.

Of the 20 patients included in the study, 14 (70%) patients were complicated by at least one major adverse event during the two years after percutaneous coronary angioplasty. 1 (5%) patient had a major complication (death from cardiovascular causes) within the first 6 months after the percutaneous coronary angioplasty procedure. 30% of patients had no complications during the 2 years after PCI. The primary endpoint was encountered in 3 (23.1%) patients in the immediate group and 3 (42.9%) patients in the staged group. The relative risk RR for the primary endpoint is higher in the staged group despite not reaching significance (RR=1.75; 95%CI 0.55 -5.53, p=0.1). The secondary endpoint was encountered in 2 (15.4%) patients in the immediate group and 3 (42.9%) patients in the staged group. The relative risk RR for the secondary endpoint is higher in the staged group despite not reaching significance (RR=2.25; 95%CI 0.74 – 6.77, p=0.3). Predictive factors for the primary and secondary endpoints were found to be: female gender and older age.