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The percutaneous coronary intervention (PCI) of a non-infarct artery at the time of primary PCI for patients with acute myocardial infarction (AMI) is still debatable. The purpose was to evaluate the long-term outcomes according to the treatment strategy of non-culprit lesions among the AMI patients with multivessel disease who underwent primary PCI or early invasive PCI.
Among 615 AMI patients, 333 patients with multivessel disease were analyzed retrospectively in a single center. Among them, 133 patients underwent culprit lesion only PCI (group 1), 120 patients underwent non-culprit lesion PCI at the time of primary culprit lesion PCI simultaneously (group 2), and 80 patients underwent second staged PCI for non-culprit lesion shortly after culprit lesion primary PCI (group 3). The clinical outcomes including all-cause mortality, non-fatal MI and repeated admission because of heart failure were assessed for 36 months.
Patients with group 1 showed older and had more non-ST elevation AMI. During 36-month follow-up, there were higher incidences of major adverse cardiac event (MACE) in group 1 [28 (21%) in group 1, 16 (13%) patients in group 2, 9 (12%) patients with group 3, p=0.02, Figure]. During 6-month follow-up, staged PCI showed the better tendency, but there was no significant difference of event occurrence between staged and simultaneously PCI of a non-culprit lesion. Similarly, ST-segment elevation myocardial infarction (STEMI) patients (n=127) also showed significant better MACE-free survivals who performed Non-culprit PCI (simultaneously and staged) compared to culprit-only PCI (p=0.02).
In AMI patients with multivessel diseases, complete revascularization was not harmful. The strategy of staged PCI for non-culprit lesion PCI after culprit lesion primary PCI might be encouraged for both STEMI and non-ST-segment elevation myocardial infarction (NSTEMI) patients.