Acute multivessel revascularization improves 1-year outcome in ST-elevation myocardial infarction A nationwide study cohort from the AMIS Plus registry

Background: The optimal strategy for percutaneous coronary intervention (PCI) of ST-segment elevation myocardial infarction (STEMI) in multi-vessel disease (MVD), i.e., multi-vessel PCI (MV-PCI) vs. PCI of the infarct-related artery only (IRA-PCI), still remains unknown. Methods: Patients of the AMIS Plus registry admitted with an acute coronary syndrome were contacted after a median of 378 days (interquartile range 371-409). The primary end-point was all-cause death. The secondary end-point included all major adverse cardiovascular and cerebrovascular events (MACCE) including death, reinfarction, re-hospitalization for cardiac causes, any cardiac re-intervention, and stroke. Results: Between 2005 and 2012, 8330 STEMI patients were identified, of whom 1909 (24%) had MVD. Of these, 442 (23%) received MV-PC1 and 1467 (77%) IRA-PCI. While all-cause mortality was similar in both groups (2.7% both, p > 0.99), MACCE was significantly lower after MV-PCI vs. IRA-PC1 (15.6% vs. 20.0%, p = 0.038), mainly driven by lower rates of cardiac re-hospitalization and cardiac re-intervention. Patients undergoing MV-PC1 with drug-eluting sterns had lower rates of all-cause mortality (2.1% vs. 7.4%, p = 0.026) and MACCE (14.1% vs. 25.9%, p = 0.042) compared with those receiving bare metal stents (BMS). In multivariate analysis, MV-PC1 (odds ratio, OR 0.69, 95% CI 0.51-0.93, p = 0.017) and comorbidities (Charlson index >= 2; OR 1.42, 95% CI 105-1.92, p = 0.025) were independent predictors for 1-year MACCE. Conclusion: In an unselected nationwide real-world cohort, an approach using immediate complete revascularization may be beneficial in STEMI patients with MVD regarding MACCE, specifically when drug-eluting stents are used, but not regarding mortality. This has to be tested in a randomized controlled trial. (C) 2014 Elsevier Ireland Ltd. All rights reserved.