Original Research

DOI: 10.4244/EIJ-D-23-00882

Immediate versus staged complete revascularisation in patients presenting with STEMI and multivessel disease

Paola Scarparo1, MD; Jacob J. Elscot1, BSc; Hala Kakar1, MD; Wijnand K. den Dekker1, MD, PhD; Johan Bennett2, MD, PhD; Manel Sabaté3, MD, PhD; Giovanni Esposito4, MD, PhD; Alberto Ranieri De Caterina5, MD, PhD; Bert Vandeloo6, MD; Paul Cummins1, RN; Mattie Lenzen1, PhD; Joost Daemen1, MD, PhD; Salvatore Brugaletta3, MD, PhD; Eric Boersma1, PhD; Nicolas M. Van Mieghem1, MD, PhD; Roberto Diletti1, MD, PhD; for the BioVasc investigators

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.

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Volume 20 Number 14
Jul 15, 2024
Volume 20 Number 14
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