Immediate versus staged complete revascularisation in patients presenting with STEMI and multivessel disease.
EuroIntervention
; 20(14): e865-e875, 2024 Jul 15.
Article
in En
| MEDLINE
| ID: mdl-39007832
ABSTRACT
BACKGROUND:
Complete revascularisation is supported by recent trials in patients with ST-elevation myocardial infarction (STEMI) and multivessel disease (MVD) without cardiogenic shock. However, the optimal timing of non-culprit lesion revascularisation is currently debated.AIMS:
This prespecified analysis of the BioVasc trial aims to determine the effect of immediate complete revascularisation (ICR) compared to staged complete revascularisation (SCR) on clinical outcomes in patients with STEMI.METHODS:
Patients presenting with STEMI and MVD were randomly assigned to ICR or SCR. The primary endpoint was the composite of all-cause mortality, myocardial infarction, any unplanned ischaemia-driven revascularisation, or cerebrovascular events at 1-year post-index procedure.RESULTS:
Between June 2018 and October 2021, 608 (ICR 305, SCR 303) STEMI patients were enrolled. No significant differences between ICR and SCR were observed at 1-year follow-up in terms of the primary endpoint (7.0% vs 8.3%, hazard ratio [HR] 0.84, 95% confidence interval [CI] 0.47-1.50; p=0.55) all-cause mortality (2.3% vs 1.3%, HR 1.77, 95% CI 0.52-6.04; p=0.36), myocardial infarction (1.7% vs 3.3%, HR 0.50, 95% CI 0.17-1.47; p=0.21), unplanned ischaemia-driven revascularisation (4.1% vs 5.0%, HR 0.80, 95% CI 0.38-1.71; p=0.57) and cerebrovascular events (1.4% vs 1.3%, HR 1.01, 95% CI 0.25-4.03; p=0.99). At 30-day follow-up, a trend towards a reduction of the primary endpoint in the ICR group was observed (ICR 3.0% vs SCR 6.0%, HR 0.50, 95% CI 0.22-1.11; p=0.09). ICR was associated with a reduction in overall hospital stay (ICR median 3 [interquartile range {IQR} 2-5] days vs SCR median 4 [IQR 3-6] days; p<0.001).CONCLUSIONS:
Clinical outcomes at 1 year were similar for STEMI patients who had undergone ICR and those who had undergone SCR.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Coronary Artery Disease
/
Percutaneous Coronary Intervention
/
ST Elevation Myocardial Infarction
Limits:
Aged
/
Female
/
Humans
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Male
/
Middle aged
Language:
En
Journal:
EuroIntervention
Journal subject:
ANGIOLOGIA
/
CARDIOLOGIA
/
TERAPEUTICA
Year:
2024
Document type:
Article
Affiliation country:
Country of publication: