Early Angio-Guided Complete Revascularization versus Culprit Vessel PCI Followed by Ischemia-Guided Staged PCI in STEMI Patients with Multivessel Disease

Meliga, Emanuele; Fiorina, Claudia; Valgimigli, Marco; Belli, Riccardo; Gagnor, Andrea; Sheiban, Imad; Resmini, Chiara; Tizzani, Emanuele; Aranzulla, Tiziana Claudia; Scrocca, Innocenzo; Benedictis, Mauro De; Conte, Maria Rosa

doi:10.1111/j.1540-8183.2011.00666.x

Cited by 29 publications

(12 citation statements)

References 25 publications

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“…In addition, another reasonable explanation would be the fact that the inflammatory reaction triggered during the ACS process responsible for the plaque instability in STEMI was not limited to the culprit lesion, consequently compromising the entire coronary tree [ 23 ] . Although it did not occur in our sample, Meliga et al [ 36 ] reported that the complete revascularization of these patients should not be based only on angiographic findings but ideally should be guided by evidence of correlated ischemia, as justified by the high risk of periprocedural ischemic complications.…”

Section: Discussionmentioning

confidence: 76%

Management of multivessel coronary disease after primary angioplasty: staged reintervention versus optimized clinical treatment and two-year follow-up

Paula¹,

Godoy²,

Santos³

et al. 2014

Revista Brasileira De Cirurgia Cardiovascular

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Objective In the clinical scenario of ST-segment elevation acute myocardial infarction, several patients with multivessel coronary atherosclerotic disease are discharged without a defined strategy to monitor the residual atherosclerotic lesions. The clinical endpoints evaluated were cardiovascular death, symptoms of angina pectoris, rehospitalization for a new acute coronary syndrome, and the necessity of reintervention during the two-year follow-up. MethodsThis observational, prospective, and historical study included multivessel coronary atherosclerotic disease patients who were admitted to a tertiary care university hospital with ST-segment elevation acute myocardial infarction and underwent primary percutaneous coronary intervention with stent implantation only at the culprit lesion site; these patients were monitored in the outpatient clinic according to two treatments: the Clinical Group - CG (optimized pharmacological therapy associated with counseling for a healthy diet and cardiac rehabilitation) or the Intervention Group - IG (new staged percutaneous coronary intervention or surgical coronary artery bypass graft surgery combined with the previously prescribed treatment). Results Of 143 patients consecutively admitted with ST-segment elevation acute myocardial infarction, 57 were eligible for the study (CG=44 and IG=13). Regarding the clinical endpoints, the cardiovascular death rate did not differ between the CG and IG. The symptom of angina pectoris and the rehospitalization rate for a new episode of acute coronary syndrome were accentuated in the CG (P=0.020 and P=0.049, respectively) mainly in individuals with evidence of ischemia evidenced by myocardial scintigraphy (P<0.001 and P=0.001, respectively) which culminated in an even greater need for reintervention (P=0.001) in this subgroup of patients. Conclusion The staged intervention was demonstrated to be safe and able to reduce angina pectoris and rehospitalization for a new episode of acute coronary syndrome. In addition, it decreases the likelihood of unplanned reinterventions of patients without ischemia evidenced by myocardial scintigraphy.

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Section: Discussionmentioning

confidence: 76%

Management of multivessel coronary disease after primary angioplasty: staged reintervention versus optimized clinical treatment and two-year follow-up

Paula¹,

Godoy²,

Santos³

et al. 2014

Revista Brasileira De Cirurgia Cardiovascular

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“…(2) It could provide a better appraisal of the revascularization strategy, including avoiding unnecessary stenting when the residual stenosis is not deemed significant . (3) In STEMI case, the repeated angiogram may allow treatment of a nonculprit artery in patients with multivessel disease . However, the disadvantages of deferred‐stenting strategy with higher costs, prolonged hospitalization, and the risk of reocclusion should also be considered.…”

Section: Discussionmentioning

confidence: 99%

Deferred Versus Immediate Stenting in Patients With ST‐Segment Elevation Myocardial Infarction: A Systematic Review and Meta‐Analysis

Qiao

Pan

Zhou

et al. 2017

JAHA

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BackgroundA number of studies have evaluated the efficacy of deferred stenting vs immediate stenting in patients with ST‐segment elevation myocardial infarction, but the findings were not consistent across these studies. This meta‐analysis aims to assess optimal treatment strategies in patient with ST‐segment elevation myocardial infarction.Methods and ResultsWe searched the PubMed, EMBASE, and the Cochrane Library for studies that assessed deferred vs immediate stenting in patients with ST‐segment elevation myocardial infarction. Nine studies including 1456 patients in randomized controlled trials and 719 patients in observational studies were included in the meta‐analysis. No significant differences were observed in the incidence of no‐ or slow‐reflow between deferred stenting and immediate stenting in randomized controlled trials (odds ratio [OR] 0.51, 95%CI 0.17‐1.53, P=0.23, I2=70%) but not in observational studies (OR 0.13, 95%CI 0.06‐0.31, P<0.0001, I2=0%). Deferred stenting was associated with an increase in long‐term left ventricular ejection fraction (weighted mean difference 1.90%, 95%CI 0.77‐3.03, P=0.001, I2=0%). No significant differences were observed in the rates of major adverse cardiovascular events (OR 0.53, 95%CI 0.27‐1.01, P=0.06 [randomized OR 0.98, 95%CI 0.73‐1.30, P=0.87, I2=0%; nonrandomized OR 0.30, 95%CI 0.15‐0.58, P=0.0004, I2=0%]), major bleeding (OR=0.1.61, 95%CI 0.70‐3.69, P=0.26, I2=0%), death (OR=0.78, 95%CI 0.53‐1.15, P=0.22, I2=0%), MI (OR=0.97, 95%CI 0.34‐2.78, P=0.96, I2=35%) and target vessel revascularization (OR 0.97, 95%CI 0.40‐2.37, P=0.95, I2=24%), between deferred and immediate stenting.ConclusionsCompared with immediate stenting, a deferred‐stenting strategy did not reduce the occurrence of no‐ or slow‐reflow, death, myocardial infarction, or repeat revascularization compared with immediate stenting in patients with ST‐segment elevation myocardial infarction, but showed an improved left ventricular function in the long term.

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“…CR was defined as the absence of total occlusion, with no residual stenosis of >70% found in any major coronary artery or major branch, at discharge, based on visual assessment [15,16]. To validate the visual assessment, quantitative coronary angiography (QCA) was performed in 254 lesions and compared with visual assessment; there was no significant difference between the two methods (P = 0.41, data not shown).…”

Section: Methodsmentioning

confidence: 99%

Impact of completeness of revascularization by coronary intervention on exercise capacity early after acute ST-elevation myocardial infarction

Zhao

Bai

Zhang

et al. 2014

J Cardiothorac Surg

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BackgroundThe importance of achieving complete revascularization by percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (MI) on exercise capacity remains unclear.ObjectiveTo compare exercise capacity early after acute ST-elevation myocardial infarction (STEMI), in patients receiving PCI with stenting, between those completely revascularized (CR) and those incompletely revascularized (IR).MethodsWe retrospectively reviewed 326 patients [single-vessel disease (SVD) group, 118 patients; multivessel disease (MVD) with CR group, 112 patients; MVD with IR group, 96 patients] who underwent cardiopulmonary exercise testing 7–30 days after STEMI to measure peak oxygen uptake (VO2peak), oxygen uptake at anaerobic threshold (VO2AT), and peak oxygen pulse. Demographic data, presence of concomitant diseases, STEMI characteristics, and echocardiography and angiography findings were evaluated.ResultsMost patients were male (89.0%) and mean age was 55.6 ± 11.2 years. Ischemic ST deviation occurred in 7.1%, with no significant difference between groups. VO2peak and VO2AT did not differ significantly between groups, despite a trend to be lower in the CR and IR groups compared with the SVD group. Peak oxygen pulse was significantly higher in the SVD group than in the IR group (p = 0.005). After adjustment for age, gender, body mass index, cardiovascular risk factors, MI characteristics and echocardiography parameters, CR was not an independent predictor of VO2peak (OR = −0.123, 95% confidence interval [CI] -2.986 to 0.232, p = 0.093), VO2AT (OR = 0.002, 95% CI 1.735 to 1.773, p = 0.983), or peak oxygen pulse (OR = −0.102, 95% CI −1.435 to 0.105, p = 0.090).ConclusionCR in patients with STEMI treated with PCI for multivessel disease might show no benefit on short-term exercise tolerance over IR.

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Early Angio-Guided Complete Revascularization versus Culprit Vessel PCI Followed by Ischemia-Guided Staged PCI in STEMI Patients with Multivessel Disease

Abstract: Early complete revascularization based only on angiographic findings in patients with STEMI and MVD is associated with an excess of periprocedural/re-MI and with a significantly higher incidence of MACE at follow-up.

Cited by 29 publications

References 25 publications

Management of multivessel coronary disease after primary angioplasty: staged reintervention versus optimized clinical treatment and two-year follow-up

Management of multivessel coronary disease after primary angioplasty: staged reintervention versus optimized clinical treatment and two-year follow-up

Deferred Versus Immediate Stenting in Patients With ST‐Segment Elevation Myocardial Infarction: A Systematic Review and Meta‐Analysis

Impact of completeness of revascularization by coronary intervention on exercise capacity early after acute ST-elevation myocardial infarction

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