Abstract 12825: Immediate versus Staged Complete Revascularization in Acute ST-segment Elevation Myocardial Infarction Patients With Multi-Vessel Disease Undergoing Primary Percutaneous Coronary Intervention: Prospective, Randomized, Multicenter Trial of Complete versus Culprit Lesion Revascularization in Acute ST-segment Elevation Myocardial Infarction Patients With Multivessel Disease Undergoing Primary Percutaneous Coronary Intervention With Everolimus Eluting Stent (cocua Trial)

Abstract

Background: In the present study, we aimed to compare the 12-month clinical outcomes of immediate versus staged complete revascularization in acute ST-segment elevation myocardial infarction (STEMI) patients with multivessel disease undergoing primary percutaneous coronary intervention (PCI) with everolimus-eluting stents (EES). Method: A total of 248 patients were enrolled in a prospective, randomized, open-label, multicenter registry. Immediate complete revascularization was defined as simultaneous PCI of the culprit and non-culprit lesions during the index procedure (Immediate group). Staged complete revascularization was defined as PCI of non-culprit lesion as a separate staged procedure after the culprit lesion PCI (mean 4.4 days, interquartile range; 1 to 11.4, Staged group). The study end points were major adverse cardiovascular events (MACE; the composite of total death, recurrent myocardial infarction, and revascularization), and individual hard endpoints including cardiac death, stent thrombosis and stroke at 12 months clinical follow up. Results: Although the incidence of MACE was not significantly different between the two groups (11.6% vs. 7.5%, p = 0.313), the incidence of total death was higher in the immediate group than the staged group (9.7% vs. 2.8%, P=0.040). Despite the incidence of target lesion and vessel revascularization were similar, there was a trend toward higher incidence of TLR- MACE in the immediate group than the staged group (9.7% vs. 3.7%, p =0.086). There was no significant difference in the risk of in-hospital complications including transfusion, bleeding, acute renal failure or acute heart failure between the groups. Conclusion: For STEMI patients with multi-vessel disease undergoing primary PCI with drug-eluting stents, routine immediate complete revascularization should not be justified possibly due to higher event risks.