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A randomised trial of target-vessel versus multi-vessel revascularisation in ST-elevation myocardial infarction: major adverse cardiac events during long-term follow-up
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  1. Luigi Politi,
  2. Fabio Sgura,
  3. Rosario Rossi,
  4. Daniel Monopoli,
  5. Elisa Guerri,
  6. Chiara Leuzzi,
  7. Francesca Bursi,
  8. Giuseppe Massimo Sangiorgi,
  9. Maria Grazia Modena
  1. Institute of Cardiology, Policlinico University Hospital, Modena, Italy
  1. Correspondence to Dr Luigi Politi, Institute of Cardiology, Policlinico University Hospital, Via del Pozzo 71, Modena 41100, Italy; luigi.politi{at}unimore.it

Abstract

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

Methods The outcomes of 214 consecutive patients with STEMI and multivessel CAD undergoing primary angioplasty were studied. Before the first angioplasty patients were randomly assigned to three different strategies: culprit vessel angioplasty-only (COR group); staged revascularisation (SR group) and simultaneous treatment of non-IRA (CR group).

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

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

  • Coronary angioplasty (percutaneous coronary intervention)
  • ST-elevation myocardial infarction

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Footnotes

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Ethics Commitee of Policlinico Hospital, Modena, Italy.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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