Short term follow-up of culprit only revascularization versus total revascularization in primary percutaneous coronary intervention in patients with multivessel disease

Peer review under responsibility of Alexandria University Faculty of Medicine.

Available online 14 January 2015

Abstract

Background

Patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease are common. It is unknown whether complete revascularization in these patients is superior.

Objectives

This study evaluated the short term outcome of culprit only revascularization compared to total revascularization in the setting of primary percutaneous coronary intervention in patients with STEMI.

Methods

The study included 40 patients with acute STEMI who were presented within 12 h from onset of symptoms. All patients had multivessel disease on emergency coronary angiography. Primary PCI was performed in all patients. According to study protocol, patients were divided into 2 groups: group A (20 patients) included patients who underwent culprit artery only revascularization, while group B (20 patients) had total revascularization. In-hospital and 30 days outcome (mortality, re-infarction, heart failure, recurrence of angina symptoms, cerebrovascular stroke, need for revascularization) were reported.

Results

All cause mortality was reported in one patient from group B (5%). No re-infarction. Recurrence of ischemic symptoms was reported in 15% of patients (25% versus 5% in groups A and B respectively, P = 0.2). Heart failure was evident in 15% of all patients (15% in each group). Composite end point of adverse cardiovascular events was reported in 37.5% of all patients (40% versus 35% in groups A and B respectively, P = 0.5). Contrast induced nephropathy was evident in 47.5% of patients (10% versus 35% in groups A and B respectively, P = 0.08), subacute stent thrombosis occurred in 2 patients (5%), (10% in group B but not in group A, P = 0.4).

Conclusion

Both treatment strategies carry equivalent short term outcome among patients with STEMI treated with PPCI.

Keywords:

• Myocardial infarction
• Reperfusion
• Primary PCI

Notes

Peer review under responsibility of Alexandria University Faculty of Medicine.

Available online 14 January 2015