Timing of Complete Revascularization with Multivessel PCI for Myocardial Infarction
12 Oct 2023 • In patients with ST-segment elevation myocardial infarction (STEMI) with multivessel coronary artery disease, the time at which complete revascularization of nonculprit lesions should be performed remains unknown.
The Multivessel Immediate versus Staged Revascularization in Acute Myocardial Infarction (MULTISTARS AMI) trial was designed to investigate whether immediate multivessel PCI at the time of primary PCI was noninferior to staged multivessel PCI in patients in hemodynamically stable condition with STEMI and multivessel coronary artery disease.
- In the trial, 418 & 422 patients underwent immediate multivessel PCI and staged multivessel PCI respectively.
- 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.
An immediate multivessel PCI approach may also reduce the amount of total contrast volume and radiation exposure and may avoid the need for an additional arterial puncture, later revascularization procedures, or a second hospitalization, thereby potentially shortening the overall length of hospital stay.
In addition, immediate multivessel PCI may be preferred by some patients because delaying the treatment of nonculprit lesions may be worrisome to them.
Source: NEJM | Read full story