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Multivessel Coronary Disease in ST-Elevation Myocardial Infarction: Three Different Revascularization Strategies and Long-Term Outcomes
  1. Luigi Politi (luigi.politi{at}unimore.it)
  1. Institute of Cardiology, Policlinico University Hospital, Modena, Italy
    1. Fabio Sgura
    1. Institute of Cardiology, Policlinico University Hospital, Modena, Italy
      1. Rosario Rossi
      1. Institute of Cardiology, Policlinico University Hospital, Modena, Italy
        1. Daniel Monopoli
        1. Institute of Cardiology, Policlinico University Hospital, Modena, Italy
          1. Elisa Guerri
          1. Institute of Cardiology, Policlinico University Hospital, Modena, Italy
            1. Chiara Leuzzi
            1. Institute of Cardiology, Policlinico University Hospital, Modena, Italy
              1. Francesca Bursi
              1. Institute of Cardiology, Policlinico University Hospital, Modena, Italy
                1. Giuseppe Massimo Sangiorgi
                1. Institute of Cardiology, Policlinico University Hospital, Modena, Italy
                  1. Maria Grazia Modena
                  1. Institute of Cardiology, Policlinico University Hospital, Modena, Italy

                    Abstract

                    Background: Few reports described outcomes of complete compared with infarct related artery (IRA) only revascularization in patients with ST elevation myocardial infarction (STEMI) and multivessel coronary disease (CAD). Moreover there are no studies comparing simultaneous treatment of non-IRAs with the IRA treatment followed by elective procedure for the other lesions (staged revascularization).

                    Methods: We studied the outcomes of 214 consecutive patients with STEMI and multivessel CAD undergoing primary angioplasty. Before the first angioplasty patients were randomized to 3 different strategies: 1) culprit vessel angioplasty only (COR group), 2) staged revascularization (SR group), and 3) simultaneous treatment of non-IRAs (CR group).

                    Results: During a mean follow-up of 2.5 years, 42 (50.0%) patients in COR group experienced at least one major adverse cardiac event (MACE), 13 (20.0%) in SR group, and 15 (23.1%) in CR group, p<0.001. In-hospital death, repeat revascularization and re-hospitalization occurred more frequently in COR group (all p<0.05), while there was no significant difference in re-infarction among the 3 groups. Survival free of MACE was significantly reduced in COR group but it was similar in CR and SR groups.

                    Conclusions: Culprit vessel only angioplasty was associated with the highest rate of long-term MACE as compared to multivessel treatment. Patients scheduled for staged revascularization experienced a similar rate of MACE as patients undergoing complete simultaneous treatment of non-IRAs.

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