Timing of Complete Revascularization with Multivessel PCI for Myocardial Infarction.
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Stähli Barbara E, Varbella Ferdinando, Linke Axel, Schwarz Bettina, Felix Stephan B, Seiffert Moritz, Kesterke Rahel, Nordbeck Peter, Witzenbichler Bernhard, Lang Irene M, Kessler Mirjam, Valina Christian, Dibra Alban, Rohla Miklos, Moccetti Marco, Vercellino Matteo, Gaede Luise, Bott-Flügel Lorenz, Jakob Philipp, Stehli Julia, Candreva Alessandro, Templin Christian, Schindler Matthias, Wischnewsky Manfred, Zanda Greca, Quadri Giorgio, Mangner Norman, Toma Aurel, Magnani Giulia, Clemmensen Peter, Lüscher Thomas F, Münzel Thomas, Schulze P Christian, Laugwitz Karl-Ludwig, Rottbauer Wolfgang, Huber Kurt, Neumann Franz-Josef, Schneider Steffen, Weidinger Franz, Achenbach Stephan, Richardt Gert, Kastrati Adnan, Ford Ian, Maier Willibald, Ruschitzka Frank, MULTISTARS AMI Investigators
Аннотация
METHODS: We performed an international, open-label, randomized, noninferiority trial at 37 sites in Europe. Patients in a hemodynamically stable condition who had STEMI and multivessel coronary artery disease were randomly assigned to undergo immediate multivessel percutaneous coronary intervention (PCI; immediate group) or PCI of the culprit lesion followed by staged multivessel PCI of nonculprit lesions within 19 to 45 days after the index procedure (staged group). The primary end point was a composite of death from any cause, nonfatal myocardial infarction, stroke, unplanned ischemia-driven revascularization, or hospitalization for heart failure at 1 year after randomization. The percentages of patients with a primary or secondary end-point event are provided as Kaplan-Meier estimates at 6 months and at 1 year.
RESULTS: We assigned 418 patients to undergo immediate multivessel PCI and 422 to undergo staged multivessel PCI. A primary end-point event occurred in 35 patients (8.5%) in the immediate group as compared with 68 patients (16.3%) in the staged group (risk ratio, 0.52; 95% confidence interval, 0.38 to 0.72; P<0.001 for noninferiority and P<0.001 for superiority). Nonfatal myocardial infarction and unplanned ischemia-driven revascularization occurred in 8 patients (2.0%) and 17 patients (4.1%), respectively, in the immediate group and in 22 patients (5.3%) and 39 patients (9.3%), respectively, in the staged group. The risk of death from any cause, the risk of stroke, and the risk of hospitalization for heart failure appeared to be similar in the two groups. A total of 104 patients in the immediate group and 145 patients in the staged group had a serious adverse event.
CONCLUSIONS: Among patients in hemodynamically stable condition with STEMI and multivessel coronary artery disease, immediate multivessel PCI was noninferior to staged multivessel PCI with respect to the risk of death from any cause, nonfatal myocardial infarction, stroke, unplanned ischemia-driven revascularization, or hospitalization for heart failure at 1 year. (Supported by Boston Scientific; MULTISTARS AMI ClinicalTrials.gov number, NCT03135275.).