Objective: Evaluation of prognostic impact of complete revascularization (CR) on P admitted with ST segment elevation myocardial infarction (STEMI) in CS and multivessel disease (MVD).
Material and methods: Retrospective analysis of P data admitted due to STEMI and CS and MVD at multicentric registry between 2000-2018. Compared demographic and clinical characteristics of P who were submitted to CR (group 1 – G1) versus who did not (group 2 – G2) and evaluated its prognostic impact.
Results: Admitted 7919 P with STEMI, which 295 (3.7%) on CS. 46.8% of the P on CS had MVD, 69.6% were submitted to CR. G1 P were younger (61±11 vs 73±12 years, p<0.001). The STEMI location was predominantly anterior (80%) in G1 and inferior in G2 (50%). The stablished timings symptoms start - reperfusion therapy and first medical contact - reperfusion were not statistically different between groups. 20% of G1 P did more than one coronarography during hospitalization. The anterior descendent was the artery more frequently involved in both groups (80 vs 89.8%) being the culprit lesion in 47.4% of G1 P and in 27.7% of G2 P, where the most frequently was the right coronary (43.4%, p <0.001). The majority of G1 P (95%) had 2-vessel disease; in G2 53.4% had 2-vessel disease and 46.6% 3-vessel disease (p<0.001). All the G1 P did PCI; in G2, 96.6% did PCI and 3.4% had a hybrid technique (in 2.3% coronary artery bypass grafting planned after hospital discharge). Other interventions during hospitalization were needed, namely non-invasive ventilation (35 vs 21.6%), invasive ventilation (30 vs 34.1%), intra-aortic pump (20 vs 17%) and temporary pacemaker (5 vs 25%), not statistically significant. The stablished endpoints were reinfarction rate (5% between G1 P vs 0%), AHF (70 vs 83%), stroke (5.3 vs 0%) and in hospital death (35 vs 37.5%), not statistically significant.
Conclusion: Although the evaluated endpoints are different and measured at different timings, our results do not appear to follow the trends presented in CULPRIT-SHOCK trial probably as a result of the small sample size and the shorter follow up time.