Safety and feasibility of complete simultaneous revascularization during primary PCI in patients with STEMI and multi-vessel disease

BackgroundContemporary guidelines recommend to dilate only the infarct-related-artery (culprit only revascularization) during the initial procedure in patients with STEMI and multi-vessel disease treated with 1ry PCI, leaving the other stenosed vessels untreated to be dilated during a second elective procedure (staged revascularization). Recently, with the advent of time, experience, expertise, and technique the multi-vessel PCI procedure became more reliable, predictable, and reproducible. We therefore believe that it was reasonable in our study to reinvestigate the clinical outcomes of complete revascularization strategy during the index procedure in patients with STEMI and multi-vessel disease.MethodsA total of 78 patients (72 males and 6 females) with ST-elevation MI presented within 12 h from the onset of symptom who had at least two angiographically-documented diseased coronary arteries (luminal diameter narrowing ⩾70%) and received primary PCI were included. They were randomly assigned to receive either PCI for culprit vessel only in the initial procedure (SR group) followed by another session of angioplasty to other diseased vessels (within 7 days), or (CR group) consisted of 42 patients who had received complete revascularization during the initial procedure after intracoronary administration of nitroglycerin to avoid stenting of functionally non-significant lesions. The combined incidence of MACE including death, recurrent myocardial infarction, re-hospitalization for angina and cerebrovascular accidents during 1 year follow up was recorded.ResultsThe baseline characteristics were well balanced between the study groups with the angiographic and procedural data showed no significant difference. The study end point combining death, MI, readmission because of recurrent ischemia or cerebrovascular accidents at 1-year follow-up occurred in 19.4% of patients with the complete staged strategy and 26.2% of patients with the complete simultaneous strategy (P = 0.5).ConclusionA simultaneous multi-vessel strategy during primary PCI is safe and feasible with no clear long term benefits in MACE rates over staged multi-vessel strategy. These data suggest that the decision to perform a simultaneous complete revascularization or to limit the procedure to culprit vessel only followed by elective intervention of the non-culprit vessels in patients with AMI and multi-vessel disease remains a decision to be made by individual operators and patients.