Cardiologie clinique et expérimentale
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Infarct Related Artery only Versus Multivessel Revascularization during Primary PCI for STEMI

Qarawani Dahud, Nahir Menachem, Ghasan Salameh and Yonathan Hasin

Background: Guidelines for ST Elevation Myocardial Infarction (STEMI) recommend for multivessel disease that only the culprit vessel be treated and that other diseased vessels be addressed in another time.

Methods: STEMI patients with multivessel disease undergoing primary PCIs in our center between January 2001 and April 2011 were divided into: 1- Culprit only PCI and 2- Multivessel PCI during the index procedure. Mortality rates and clinical outcomes were compared between the two groups in hospital and at 12 months.

Results: 491 patients had STEMI and multivessel disease. In 341 (69.5%) immediate multivessel PCI was performed, in 150 (30.5%) patients a culprit vessel only was treated and the rest was deferred for another procedure. Multivessel PCI was associated with Shorter hospitalization (4.4 ± 1.27 versus 7.6 ± 2.1, P=0.01), reduced incidence of 12 months major adverse cardiac events (recurrent ischemia, reinfarction, acute heart failure and mortality (16.1 versus 35.3%, P=0.01). A significant lower rate of recurrent ischemic episodes (5.6% versus 11.3%, P=0.02), myocardial reinfarction (5% versus 10%, P=0.01), reintervention (9.4% versus 26%, P=0.01). Transient renal dysfunction was more common in multivessel PCI (8.5% versus 4% P=0.01). In-hospital mortality (4.1% vs 4.4% p=0.9) was similar, while 1 year mortality tended to be decreased in the multivessel group (6.9% vs 7.4%), p=0.06).

Conclusion: Multivessel revascularization resulted in an improved clinical course. Our findings support that multivessel PCI during STEMI can be feasible and safe. Decisions about PCI of the non-infarct vessel(s) should be individualized. Further large, randomized trials will help us solve this dilemma.