Revascularização Completa Versus Tratamento da Artéria Culpada no Infarto com Supradesnivelamento do Segmento ST: Registro Multicêntrico

Abstract

Background: Data on the management and prognosis of patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease are limited in Brazil, showing that the available revascularization strategies should be investigated Objective: To assess the outcomes of complete revascularization versus treatment of the culprit artery only in patients with STEMI and multivessel disease. Methods: A prospective cohort study was conducted at two medical centers in southern Brazil with a 1-year follow-up after the index procedure. The primary outcome was a composite of cardiac death, reinfarction, or recurrent angina, while the secondary outcome was stroke, nonfatal cardiac arrest, major bleeding, or need for reintervention. The probability of outcomes occurring was compared between the groups using binary logistic regression. A p-value < 0.05 was considered statistically significant. Results: Eighty-five patients were included. Their mean age was 62±12 years, and 61 (71.8%) were male. Fifty-eight (68.2%) were treated with complete revascularization and 27 (31.8%) with incomplete revascularization. The chance of both the primary and secondary outcomes occurring was significantly greater among patients treated with incomplete revascularization when compared to those treated with complete revascularization (odds ratio [OR] 5.1, 95% confidence interval [CI] 1.6-16.1 vs. OR 5.2, 95% CI 1.2-22.9, respectively), as well as cardiac death (OR 6.4, 95% CI 1.2-35.3). Conclusion: Registry data from two centers in southern Brazil demonstrate that the complete revascularization strategy is associated with a significant reduction in primary and secondary outcomes in a 1-year follow-up when compared to the incomplete revascularization strategy (Arq Bras Cardiol. 2020; 115(2):229-237

Análise das Estratégias de Revascularização em Doentes com Infarte Agudo do Miocárdio em Choque Cardiogênico – Resultados do Registro Português de Síndromes Coronárias Agudas

“…4 One Brazilian multicenter study demonstrated that the complete revascularization strategy was associated with a significant reduction in the primary (cardiovascular death, re-infarction, and recurring angina) and secondary (stroke, non-fatal cardiorespiratory failure, greater bleeding, or the need for reintervention) outcomes in the one-year follow-up when compared to the incomplete revascularization strategy. 5 The study based on the Portuguese NRACS involves patients with knowingly poor prognostic markers, as they are anatomically multiarterial 6 and hemodynamically in cardiogenic shock, 7 which justified the high mortality in the study. The results showed no difference between complete revascularization in the procedure index as compared to a group consisting of differed complete or incomplete revascularization in relation to the primary outcome of intrahospital death or re-infarction.…”

“…The results of similar studies demonstrate that complete revascularization is superior, but it did not involve only patients in cardiogenic shock. 5,[8][9][10] One major advantage illustrated in this study3 is the availability of a continuous, long-standing, national Registry, with a broad coverage and multiple variables that make it possible to conduct different studies; the temporary followup of events, recommendations, or interventions; and the tendency in the numbers and outcomes of ACS throughout Portugal. Brazil lacks a similar registry.…”