Author + information
- Mariusz Tomaniak1,
- Dominika Klimczak2,
- Maria Tovar3,
- Joost Daemen4,
- Jeroen Wilschut5,
- Peter de Jaegere6,
- Felix Zijlstra7,
- Nicolas Van Mieghem8 and
- Roberto Diletti9
- 1Thorax Center, Erasmus MC, Department of Interventional Cardiology, Rotterdam, Netherlands, Medical University of Warsaw, First Department of Cardiology, Warsaw, Poland
- 2Thorax Centre, Erasmus MC, Department of Interventional Cardiology, Rotterdam, Netherlands, Medical University of Warsaw, Department of Immunology, Transplant Medicine and Internal Diseases, Division of Heart Failure and Cardiac Rehabilitation, Warsaw, Poland
- 3Thorax Centre, Erasmus MC, Department of Interventional Cardiology, Rotterdam, Netherlands
- 4Erasmus MC - Thoraxcenter, United States
- 5Thoraxcenter Erasmus MC, Rotterdam, Netherlands
- 6Department of Cardiology, Erasmus MC, Rotterdam, Netherlands
- 7Thoraxcenter, Erasmus Medical Centre, Rotterdam, Netherlands
- 8Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands
- 9Thorax Center, Erasmus MC, Rotterdam, Netherlands
Diabetes mellitus (DM), multivessel disease and complex lesion subsets, such as bifurcation, chronic total occlusions, long lesions and small vessels, have been identified as factors increasing the risk of restenosis and re-intervention after stenting. The impact of different revascularization strategies in patients presenting with ST-segment elevation myocardial infarction (STEMI) and multivessel disease at high risk of restenosis remains to be clarified. The present study aims to compare culprit only (CO), ad-hoc (AH) and staged revascularization (SR) strategy among STEMI patients with multivessel disease at highest risk for restenosis.
This is an observational, single-centre study evaluating subjects with STEMI and multivessel disease with high-risk of restenosis including at least one of the following: DM, interventions on complex lesions e.g. chronic total occlusions, total stent length >38 mm, minimal stent diameter ≤2.5 mm or bifurcation. Clinical outcomes categorized according to revascularization strategy are reported at 2 years post index procedure.
A total of 519 STEMI patients at high risk of restenosis were selected for this analysis. CO, AH and SR strategies were adopted in 336 (64.7%), 89 (17.1%) and 94 (18.1%) patients. At two-year follow-up a higher rate of MACE [90 (26.8%) vs. 17 (9.3%), p = 0.001)], recurrent myocardial infarction [23 (5.4%) vs. 3 (3.3%), p = 0.027], re-PCI [63 (14.7%) vs. 3 (3.3%), p = 0.001], all-cause mortality [45 (13.4%) vs. 15 (8.2%), p = 0.081] was observed in CO, compared with the AH and SR groups. At multivariate Cox regression analysis CO revascularization strategy was an independent predictor of mortality (HR 1.88, 1.10 – 3.23, p = 0.023) and MACE (HR 3.1; 1.56 – 6.10, p = 0.001). No differences in clinical event rates were identified between the AH and SR approaches up to two years.
Complete revascularization with either ad-hoc or staged approach could improve long-term outcome in patients at risk for restenosis.
CORONARY: PCI Outcomes