Objectives Over 50% of ST-segment elevation myocardial infarction (STEMI) patients have multivessel disease, which is known to be associated with worse prognosis. The best percutaneous coronary intervention (PCI) strategy for those patients has been controversial for a few years. Recently, increasing evidence has suggested that only the infarc-related artery (IRA) should be treated with primary PCI followed by a staged PCI of the non-IRA at a later time. However, the timing of staged PCI in STEMI patients with multivessel disease remains unclear.
Methods From the OPMPM (Optimal Pathways and Methods for the Prevention and Management of coronary heart disease) registry, which was carried out in 7 major hospitals of Harbin, 126 STEMI patients with multivessel disease undergoing staged PCI were enrolled. Patients were categorised into staged PCI within 2 weeks of primary PCI (Group A, n = 56) versus staged PCI after 2 weeks of primary PCI (Group B, n = 70). The endpoints included the 1-year rates of major adverse cardiac events (MACE) and its components: death, reinfarction and target vessel revascularisation (TVR) for ischaemia.
Results There was no difference in the rate of successful reperfusion on both IRA and non-IRA in both groups. Compared with group B, a higher rate of MACE predominantly driven by reinfarction was found in group A at 1-year follow up (27.3% vs 21.2%, P < 0.05), while the rates of death and TVR were similar in two groups (P > 0.05 for all). Multivariate analysis identified that staged PCI of non-IRA within 2 weeks following primary PCI was an independent predictor for reinfarction in STEMI patients with multivessel disease (P < 0.01).
Conclusions Staged PCI of non-IRA in STEMI patients with multivessel disease should be performed at least 2 weeks after primary PCI.