What's the Optimal Timing of Complete Revascularization for STEMI with Multivessel Disease?

Overall, 1-year outcomes were better with immediate intervention in nonculprit lesions than with a later, staged approach.

Clinical guidelines recommend complete revascularization after ST-segment elevation myocardial infarction (STEMI). In an industry-funded trial, researchers assessed the optimal timing of treating nonculprit lesions by randomizing 840 patients with STEMI and multivessel coronary artery disease (CAD) at 37 sites in Europe to immediate multivessel percutaneous coronary intervention (PCI) or a staged approach: immediate PCI of the culprit lesion, then PCI of nonculprit lesions 19 to 45 days later (NCT03135275).

Incidence of the primary endpoint — death, MI, stroke, unplanned revascularization, or hospitalization for heart failure at 1 year — was significantly lower in the immediate-PCI group than the staged group (8.5% vs. 16.3%; risk ratio, 0.5…

Reviewing Author

Howard C. Herrmann, MD

Disclosures

Consultant/Advisory BoardAffluent Medical; Artedrone; Caranx; Johnson & Johnson; Medtronic; Prolifagen; Wells Fargo

EquityMicrointerventional Devices, Inc.

RoyaltiesUniversity of Pennsylvania

Grant/Research SupportAbbott Vascular; Edwards Lifesciences; Johnson & Johnson; Medtronic

Editorial BoardsCatheterization and Cardiovascular Interventions; Journal of the American College of Cardiology; Circulation: Cardiovascular Interventions; JACC Cardiovascular Interventions; JACC Case Reports; JSCAI

Leadership Positions in Professional SocietiesHeart Valve Collaboratory (Scientific Committee Member, Chair of the Publications Committee)