Management of Multivessel Coronary Disease after ST Elevation Myocardial Infarction Treated by Primary Angioplasty

  1. STEFANO RIGATTIERI M.D., Ph.D.1,
  2. GIUSEPPE BIONDI-ZOCCAI M.D.2,
  3. PASQUALE SILVESTRI M.D.1,
  4. CRISTIAN DI RUSSO M.D.1,
  5. CARMINE MUSTO M.D.1,
  6. GIUSEPPE FERRAIUOLO M.D.3,
  7. PAOLO LOSCHIAVO M.D.1

Article first published online: 13 DEC 2007

DOI: 10.1111/j.1540-8183.2007.00317.x

Issue

Journal of Interventional Cardiology

Journal of Interventional Cardiology

Volume 21, Issue 1, pages 1–7, February 2008

Additional Information

How to Cite

RIGATTIERI, S., BIONDI-ZOCCAI, G., SILVESTRI, P., RUSSO, C. D., MUSTO, C., FERRAIUOLO, G. and LOSCHIAVO, P. (2008), Management of Multivessel Coronary Disease after ST Elevation Myocardial Infarction Treated by Primary Angioplasty. Journal of Interventional Cardiology, 21: 1–7. doi: 10.1111/j.1540-8183.2007.00317.x

Author Information

  1. 1

    Interventional Cardiology Unit, Cardiology Department, “Sandro Pertini” Hospital, Rome, Italy

  2. 2

    Interventional Cardiology Unit, Cardiology Department, University of Turin, S.Giovanni Battista-Molinette Hospital, Turin, Italy

  3. 3

    Intensive Coronary Care Unit, Cardiology Department, “Sandro Pertini” Hospital, Rome, Italy

*Address for reprints: Stefano Rigattieri, M.D., Ph.D., Cardiology Department, “Sandro Pertini” Hospital, Via dei Monti Tiburtini 385, Zip code 00157, Rome, Italy. Fax: +39-06-41433481; e-mail: stefanorigattieri@yahoo.it

Publication History

  1. Issue published online: 13 DEC 2007
  2. Article first published online: 13 DEC 2007

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Background: Optimal treatment strategy of patients with ST elevation myocardial infarction (STEMI) and multivessel coronary artery disease (CAD) undergoing primary angioplasty is still unclear. Percutaneous coronary intervention (PCI) of non-culprit vessels simultaneously or soon after primary angioplasty is feasible and safe, but available data failed to consistently show a benefit in long-term clinical outcomes.

Methods: We retrospectively compared in-hospital and long-term outcomes for patients with STEMI and multivessel CAD treated by primary angioplasty with (Group 1, n=64) or without (Group 2, n=46) early, staged PCI of other angiographically significant coronary lesions. In-hospital major adverse cardiovascular events (MACE) were defined as a composite of death, periprocedural myocardial infarction after staged, elective PCI, stroke, stent thrombosis, major bleeding, and vascular complications. MACE at follow-up were defined as a composite of death, stroke, stent thrombosis, any coronary revascularization, and re-hospitalization for acute coronary syndrome.

Results: Group 1 patients underwent staged PCI 5.9 ± 3.5 days after primary angioplasty. The mean length of follow-up was 13 months (392 ± 236 days). The incidence of in-hospital MACE was 20.3% in Group 1 and 10.8% in Group 2 (P=0.186); the incidence of out of hospital MACE was 9.3% in Group 1 and 23.9% in Group 2 (P=0.037). In Group 1 in-hospital MACE were driven by periprocedural myocardial infarction after the elective procedure, which occurred in 15.6% of patients.

Conclusions: Our data show that multivessel, staged PCI in STEMI patients is associated with a low incidence of adverse events at follow-up but with a higher incidence of in-hospital MACE, mainly driven by periprocedural myocardial infarction during the elective procedure.

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