Work

Comparison of Multivessel Versus Culprit‐Vessel‐Only Revascularization in Patients With STEMI and Multivessel Disease During Primary PCI: In‐Hospital Outcomes From the CCC‐ACS Project in China

Year: 2024

Type: article

Abstract: BACKGROUND: The consensus on whether acute ST-segment elevation myocardial infarction (STEMI) patients with multivessel coronary artery disease (MVD) benefit from complete revascularization during primary percutaneous coronary intervention (PCI) is unclear. AIMS: This study aims to assess the impact of multivessel PCI (MV-PCI) versus culprit-vessel-only PCI (CV-PCI) on in-hospital outcomes in a Chinese population. METHODS: We evaluated STEMI patients with MVD undergoing PCI, registered in the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome (CCC-ACS) project, from November 2014 to December 2019. Using inverse probability of treatment weighting (IPTW) and multivariable Cox regression, we compared the incidence of in-hospital Major Adverse Cardiac Events (MACE) and other adverse clinical outcomes between the MV-PCI and CV-PCI groups. RESULTS: Among 8138 patients included, 840 (10.3%) underwent MV-PCI, and 7298 (89.7%) underwent CV-PCI. MV-PCI was associated with higher in-hospital MACE (2.0% vs. 0.9%, p = 0.005), all-cause mortality (1.7% vs. 0.7%, p = 0.003), and contrast-induced acute kidney injury (CI-AKI) (13.6% vs. 10.2%, p = 0.002), after IPTW adjustment. The multivariable Cox analysis further validated the increased risks associated with MV-PCI. CONCLUSION: In the Chinese STEMI population with MVD, participating in the CCC-ACS project, MV-PCI during primary PCI was linked to higher in-hospital adverse events compared to CV-PCI. These findings advocate for a cautious approach to MV-PCI in this setting, suggesting a potential preference for a staged PCI strategy for nonculprit vessels. TRIAL REGISTRATION: The information of clinical trial registration for CCC-ACS project can be found at http://clinicaltrials.gov/study/NCT02306616.

Source: Catheterization and Cardiovascular Interventions

DOI: 10.1002/ccd.31332