Culprit only versus complete coronary revascularization during primary PCI.

BACKGROUND: Primary percutaneous intervention (PCI) is the treatment of choice for acute ST elevation myocardial infarction. Currently it is recommended to treat only the culprit artery during the acute procedure. Only few reports describe the results of simultaneous non-culprit vessel PCI. The study hypothesizes that complete revascularization during primary PCI can be achieved safely with an improved clinical outcome during the indexed hospitalization.

METHODS: One hundred and twenty consecutive patients presented with acute ST elevation myocardial infarction (STEMI) and multivessel coronary stenosis. Ninety five underwent complete revascularization (CR): the culprit artery was opened first followed by dilatation of the other significantly narrowed arteries. Twenty five had culprit only revascularization (COR): the culprit artery only was dilated and the other arteries were left untreated during the primary PCI.

RESULTS: Complete revascularization (CR) was associated with reduced incidence of major cardiac events (recurrent ischemia, reinfarction, acute heart failure and in-hospital mortality 16.7 versus 52%, P=0.0001). There was a significant lower rate of recurrent ischemic episodes (4.2% versus 32%, P=0.002), myocardial reinfarction (3.1% versus 16%, P=0.01), reintervention (7.3% versus 32%, P=0.001), acute heart failure (9.4% versus 32%, P=0.01) during the indexed hospitalization and shorter hospitalization (4.4+/-1.27 versus 9.6+/-2.3, P=0.001) in the CR group. Transient renal dysfunction was more common in CR patients (8.4% versus 4% P=0.01). In-hospital and one year mortality were similar between the two groups.

CONCLUSION: Multivessel PCI during acute myocardial infarction is feasible and safe. Complete revascularization resulted in an improved acute clinical course. These data support a policy of complete revascularization during primary PCI for STEMI.