[Introduction] Primary percutaneous coronary intervention (PCI) is the dominant reperfusion treatment for acute ST elevation myocardial infarction (STEMI). Currently, the recommended treatment option is the culprit artery only PCI during the acute phase. We investigated the one-year clinical outcomes of multivessel and culprit-only PCI in patients with STEMI.
[Methods] In this study, total 215 patients (mean age 64±10ys) who underwent primary PCI with acute STEMI combined significant multivessel disease (Major epicardial coronary artery > 50% diameter stenosis) were analyzed. 108 patients had culprit only revascularization (COR) : Only culprit artery was revascularized. 107 patients underwent complete revascularization (CR) : the culprit artery and another significant stenotic artery were revascularized completely.
[Results] The baseline clinical and angiographic characteristics were not significantly different between the two groups. At the 6 month angiographic follow up examination, rates of in-stent restenosis of culprit lesions are similar (COR 10.1%, CR 11.4%, p=0.797). 1 year MACE (composite of cardiac death, recurrent MI, target vessel revascularization and non culprit vessel revascularization, COR 28.1%, CR 31.6%, p=0.594) was similar in both groups. However, hard endpoint including, all death (COR 8.3%, CR 18.4%, p=0.040), cardiac death (COR 7.3%, CR 18.4%, p=0.021), and recurrent MI (COR 2.1%, CR 10.2%, p=0.019) showed significant increase in the CR group. In CR patients, 66 patients were simultaneously treated during primary PCI and 41 patients were treated as second staged PCI during hospitalization. In-hospital outcomes were not different in the incidence of MACE (composite of cardiac death, recurrent MI and target lesion revascularization, 15.2% vs. 4.9%, p=0.102) and duration of hospitalization (8.7±10.4 days vs. 12.2±12.1 days, p=0.114).
[Conclusions] 1 year MACE was not significantly different between COR and CR group. In hard endpoint such as all death, cardiac death and recurrent MI, however, COR was safer and more favorable than CR.
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