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Benefit of a staged in‐hospital revascularization strategy in hemodynamically stable patients with ST‐segment elevation myocardial infarction and multivessel disease: Analyses by risk stratification
Author(s) -
Kim Min Chul,
Bae SungA,
Ahn Youngkeun,
Sim Doo Sun,
Hong Young Joon,
Kim Ju Han,
Jeong Myung Ho,
Kim HyoSoo,
Chae Shung Chull,
Cha Kwang Soo
Publication year - 2021
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.29062
Subject(s) - medicine , cardiogenic shock , cardiology , conventional pci , myocardial infarction , percutaneous coronary intervention , culprit , revascularization , coronary artery disease
Aims The proper timing and indication of revascularization for a non‐culprit artery in patients with ST‐segment elevation myocardial infarction (STEMI) and multivessel disease (MVD) without cardiogenic shock remains controversial. Methods and Results This multicenter study included patients with STEMI and MVD without cardiogenic shock. Data were analyzed at 3 years according to the percutaneous coronary intervention (PCI) strategy: immediate multivessel revascularization (MVR) ( n = 351), stepwise MVR ( n = 510), and culprit‐only PCI ( n = 1,142). The primary outcome was all‐cause mortality. The stepwise MVR group had a lower risk of all‐cause death. The results were consistent after multivariate regression, propensity‐score matching, inverse probability weighting, and Bayesian proportional hazards modeling. In subgroup analyses stratified by the Global Registry of Acute Coronary Events score, stepwise MVR also lowered the risk of all‐cause death compared to culprit‐only PCI and immediate MVR in high risk patients but not in patients at low to intermediate risk. Conclusions In patients with STEMI and MVD without cardiogenic shock, in‐hospital stepwise MVR was associated with a lower risk of all‐cause death than culprit‐only PCI or immediate MVR, particularly in the high‐risk subgroup.