Reduced risk of adverse cardiovascular events such as cardiovascular death following complete revascularization of ST-elevation myocardial infarction (STEMI) patients with multivessel disease (MVD) has been reported by recent studies. The best time to revascularize non-culprit lesions is still up for debate.
This study aimed to compare cardiac outcomes between primary percutaneous coronary intervention (pPCI) of the culprit lesion and staged PCI (sPCI) of non-culprit lesions in terms of duration.
In this study, 1,555 individuals with MVD requiring sPCI were identified from a prospectively collected sequential registry of 3,002 patients treated for STEMI by pPCI. The study population was divided into quartiles based on how long it took them to have sPCI: 0-7 days in Q1, 7-22 days in Q2, 22-42 days in Q3, and >42 days in Q4. Those with complete revascularization at the index event were excluded.
All-cause mortality, target vessel revascularization, myocardial infarction, and coronary artery bypass operations were among the major adverse cardiac events (MACEs). The analysis was done by using Cox regression and propensity score matching.
At the time of presentation, the average age was 65.7 11.5 years. Of the total study population, 21.4% (n=333) were women. Between primary percutaneous coronary intervention (pPCI) and sPCI, the average time was 28.3 days (±24.8). MACE rates were 16.5% in Q1, 21.2% in Q2, 25.8% in Q3, and 30.1%in Q4 (log-rank 0.001). sPCI remained an independent risk factor for MACE after regression analysis (hazard ratio [HR] = 1.226 [95% confidence interval [CI]: 1.129-1.331, p< 0.001]). No link could be established between the time period before sPCI and death from any cause (HR = 1.022 [95% CI: 0.925-1.129, p = 0.671]).
This study suggests that with increasing time delay between pPCI and sPCI, the risk of MACE among MVD patients after revascularization of non-culprit vessels also increases.