Korean Circ J.  2018 Nov;48(11):989-999. 10.4070/kcj.2017.0387.

Complete Versus Culprit-Only Revascularization for ST-Segment Elevation Myocardial Infarction and Multivessel Disease in the 2(nd) Generation Drug-Eluting Stent Era: Data from the INTERSTELLAR Registry

• Kwon SW
• Park SD
• Moon J
• Oh PC
• Jang HJ
• Park HW
• Kim TH
• Lee K
• Suh J
• Kang W

• KMID: 2422546
• DOI: http://doi.org/10.4070/kcj.2017.0387

Abstract

BACKGROUND AND OBJECTIVES
We aimed to compare outcomes of complete revascularization (CR) versus culprit-only revascularization for ST-segment elevation myocardial infarction (STEMI) and multivessel disease (MVD) in the 2nd generation drug-eluting stent (DES) era.
METHODS
From 2009 to 2014, patients with STEMI and MVD, who underwent primary percutaneous coronary intervention (PCI) using a 2nd generation DES for culprit lesions were enrolled. CR was defined as PCI for a non-infarct-related artery during the index admission. Major adverse cardiovascular event (MACE) was defined as cardiovascular (CV) death, non-fatal myocardial infarction, target lesion revascularization, or heart failure during the follow-up year.
RESULTS
In total, 705 MVD patients were suitable for the analysis, of whom 286 (41%) underwent culprit-only PCI and 419 (59%) underwent CR during the index admission. The incidence of MACE was 11.5% in the CR group versus 18.5% in the culprit-only group (hazard ratio [HR], 0.56; 95% confidence interval [CI], 0.37-0.86; p<0.01; adjusted HR, 0.64; 95% CI, 0.40-0.99; p=0.04). The CR group revealed a significantly lower incidence of CV death (7.2% vs. 12.9%; HR, 0.51; 95% CI, 0.31-0.86; p=0.01 and adjusted HR, 0.57; 95% CI; 0.32-0.97; p=0.03, respectively).
CONCLUSIONS
CR was associated with better outcomes including reductions in MACE and CV death at 1 year of follow-up compared with culprit-only PCI in the 2nd generation DES era.

Keyword

ST elevation myocardial infarction; Percutaneous coronary intervention

MeSH Terms

Arteries
Drug-Eluting Stents*
Follow-Up Studies
Heart Failure
Humans
Incidence
Myocardial Infarction*
Percutaneous Coronary Intervention

Figure

• 

  Figure 1 Participant flow chart. BMS = bare metal stent; CR = complete revascularization; CV = cardiovascular; DES = drug eluting stent; HF = heart failure; MACE = major adverse cardiovascular event; MI = myocardial infarction; MVD = multivessel disease; POBA = plain old balloon angioplasty; STEMI = ST-segment elevation myocardial infarction; TLR = target lesion revascularization.

• 

  Figure 2 Subgroup analyses for MACE & CV death between culprit-only versus CR. BD-DES = biodegradable polymer drug-eluting stent; CI = confidence interval; CKD = chronic kidney disease; CR = complete revascularization; CV = cardiovascular; DM = diabetes mellitus; EES = everolimus-eluting stent; EF = ejection fraction; HR = hazard ratio; LAD = left anterior descending artery; MACE = major adverse cardiovascular event; TIMI = thrombolysis in myocardial infarction; ZES = zotarolimus-eluting stent.

• 

  Figure 3 Kaplan-Meier curve for (A) MACE, (B) CV death, (C) TLR, and (D) HF.
CR = complete revascularization; CV = cardiovascular; HF = heart failure; MACE = major adverse cardiovascular event; PCI = percutaneous coronary intervention; TLR = target lesion revascularization.

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