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Randomized Controlled Trial
. 2024 Jul 15;20(14):e865-e875.
doi: 10.4244/EIJ-D-23-00882.

Immediate versus staged complete revascularisation in patients presenting with STEMI and multivessel disease

Paola Scarparo  1 , Jacob J Elscot  1 , Hala Kakar  1 , Wijnand K den Dekker  1 , Johan Bennett  2 , Manel Sabaté  3 , Giovanni Esposito  4 , Alberto Ranieri De Caterina  5 , Bert Vandeloo  6 , Paul Cummins  1 , Mattie Lenzen  1 , Joost Daemen  1 , Salvatore Brugaletta  3 , Eric Boersma  1 , Nicolas M Van Mieghem  1 , Roberto Diletti  1 , For The BioVasc Investigators
Affiliations
Randomized Controlled Trial

Immediate versus staged complete revascularisation in patients presenting with STEMI and multivessel disease

Paola Scarparo et al. EuroIntervention. .

Abstract

Background: Complete revascularisation is supported by recent trials in patients with ST-elevation myocardial infarction (STEMI) and multivessel disease (MVD) without cardiogenic shock. However, the optimal timing of non-culprit lesion revascularisation is currently debated.

Aims: This prespecified analysis of the BioVasc trial aims to determine the effect of immediate complete revascularisation (ICR) compared to staged complete revascularisation (SCR) on clinical outcomes in patients with STEMI.

Methods: Patients presenting with STEMI and MVD were randomly assigned to ICR or SCR. The primary endpoint was the composite of all-cause mortality, myocardial infarction, any unplanned ischaemia-driven revascularisation, or cerebrovascular events at 1-year post-index procedure.

Results: Between June 2018 and October 2021, 608 (ICR: 305, SCR: 303) STEMI patients were enrolled. No significant differences between ICR and SCR were observed at 1-year follow-up in terms of the primary endpoint (7.0% vs 8.3%, hazard ratio [HR] 0.84, 95% confidence interval [CI]: 0.47-1.50; p=0.55): all-cause mortality (2.3% vs 1.3%, HR 1.77, 95% CI: 0.52-6.04; p=0.36), myocardial infarction (1.7% vs 3.3%, HR 0.50, 95% CI: 0.17-1.47; p=0.21), unplanned ischaemia-driven revascularisation (4.1% vs 5.0%, HR 0.80, 95% CI: 0.38-1.71; p=0.57) and cerebrovascular events (1.4% vs 1.3%, HR 1.01, 95% CI: 0.25-4.03; p=0.99). At 30-day follow-up, a trend towards a reduction of the primary endpoint in the ICR group was observed (ICR: 3.0% vs SCR: 6.0%, HR 0.50, 95% CI: 0.22-1.11; p=0.09). ICR was associated with a reduction in overall hospital stay (ICR: median 3 [interquartile range {IQR} 2-5] days vs SCR: median 4 [IQR 3-6] days; p<0.001).

Conclusions: Clinical outcomes at 1 year were similar for STEMI patients who had undergone ICR and those who had undergone SCR.

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Conflict of interest statement

M. Sabaté has received consulting fees from Abbott and iVascular. N.M. Van Mieghem has received institutional research grants from Biotronik, Abbott, Medtronic, Edwards Lifesciences, PulseCath, Abiomed, and Daiichi Sankyo; speaker fees from Abiomed and Amgen; and a travel grant from JenaValve. R. Diletti has received institutional research grants from Biotronik, Medtronic, ACIST Medical Systems, and Boston Scientific. W.K. den Dekker has received institutional research grants from Biotronik. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1. Distribution of the time to the staged procedure.
Distribution of the time to the scheduled staged PCI. The planned staged revascularisation was completed in a substantial number of patients before the 19th day. PCI: percutaneous coronary intervention
Figure 2
Figure 2. Myocardial infarction and unplanned ischaemia-driven revascularisation at 1 year.
A) Kaplan-Meier estimates of myocardial infarction at 1 year. B) Kaplan-Meier estimates of unplanned ischaemia-driven revascularisation at 1 year. CI: confidence interval; HR: hazard ratio; ICR: immediate complete revascularisation; SCR: staged complete revascularisation
Central illustration
Central illustration. Primary composite outcome at 1 year.
Kaplan-Meier estimates of the primary composite outcome at 1 year. The primary outcome was a composite of all-cause mortality, myocardial infarction, unplanned ischaemia-driven revascularisation, or cerebrovascular events at 1 year. CI: confidence interval; HR: hazard ratio; ICR immediate complete revascularisation; SCR: staged complete revascularisation
See this image and copyright information in PMC

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