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. 2018 May;15(5):356-362.
doi: 10.11909/j.issn.1671-5411.2018.05.005.

Optimal timing of staged percutaneous coronary intervention in ST-segment elevation myocardial infarction patients with multivessel disease

Xue-Dong Zhao  1 , Guan-Qi Zhao  1 , Xiao Wang  1 , Shu-Tian Shi  1 , Wen Zheng  1 , Rui-Feng Guo  1 , Shao-Ping Nie  1
Affiliations

Optimal timing of staged percutaneous coronary intervention in ST-segment elevation myocardial infarction patients with multivessel disease

Xue-Dong Zhao et al. J Geriatr Cardiol. 2018 May.

Abstract

Background: Studies have shown that staged percutaneous coronary intervention (PCI) for non-culprit lesions is beneficial for prognosis of ST-segment elevation myocardial infarction (STEMI) patients with multivessel disease. However, the optimal timing of staged revascularization is still controversial. This study aimed to find the optimal timing of staged revascularization.

Methods: A total of 428 STEMI patients with multivessel disease who underwent primary PCI and staged PCI were included. According to the time interval between primary and staged PCI, patients were divided into three groups (≤ 1 week, 1-2 weeks, and 2-12 weeks after primary PCI). The primary endpoint was major adverse cardiovascular events (MACE), a composite of all-cause death, non-fatal re-infarction, repeat revascularization, and stroke. Cox regression model was used to assess the association between staged PCI timing and risk of MACE.

Results: During the follow-up, 119 participants had MACEs. There was statistical difference in MACE incidence among the three groups (≤ 1 week: 23.0%; 1-2 weeks: 33.0%; 2-12 weeks: 40.0%; P = 0.001). In the multivariable adjustment model, the timing interval of staged PCI ≤ 1 week and 1-2 weeks were both significantly associated with a lower risk of MACE [hazard ratio (HR): 0.40, 95% confidence intervals (CI): 0.24-0.65; HR: 0.54, 95% CI: 0.31-0.93, respectively], mainly attributed to a lower risk of repeat revascularization (HR: 0.41, 95% CI: 0.24-0.70; HR: 0.36, 95% CI: 0.18-0.7), compared with a strategy of 2-12 weeks later of primary PCI.

Conclusions: The optimal timing of staged PCI for non-culprit vessels should be within two weeks after primary PCI for STEMI patients.

Keywords: Multivessel disease; Myocardial infarction; Non-culprit lesion; Percutaneous coronary intervention; Timing.

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Figures

Figure 1.
Figure 1.. Study population.
CABG: coronary artery bypass graft; DES: drug-eluting stent; PCI: percutaneous coronary intervention; PTCA: percutaneous transluminal coronary angioplasty; STEMI: ST-segment elevation myocardial infarction.
Figure 2.
Figure 2.. Unadjusted mortality curves during follow-up for patients undergoing staged PCI in three different periods.
MACE, major adverse cardiovascular events.
Figure 3.
Figure 3.. Cox regression analysis for timing of staged PCI.
In multivariable analysis, an independent association was found between staged PCI 2-12 weeks and MACE. CI: confidence interval; HR: hazard ratio; MACE: major adverse cardiovascular events.
See this image and copyright information in PMC

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