Staged PCI better than multi vessel PCI in acute myocardial infarction
It is well documented that primary percutaneous intervention (PCI) for the culprit vessel is currently the best form of treatment for acute ST segment elevation myocardial infarction presenting in the appropriate time window. Dilemma arises in the setting of acute myocardial infarction when vessels other than the culprit vessels show lesions amenable to PCI. The current guidelines state that patients not in shock should have only culprit vessel revascularization at the time of primary PCI and other lesions should be dealt with in a staged manner at a later date.
HORIZONS-AMI (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction) trial database was accessed by a group of investigators recently to evaluate the evidence on staged versus one shot multivessel PCI in acute ST elevation myocardial infarction . They found that single sitting multivessel PCI in the setting of acute myocardial infarction was associated with higher one year mortality, cardiac mortality, definite/probable stent thrombosis, and a trend toward greater major adverse cardiovascular events (MACE). Staged PCI was independently associated with a lower all cause mortality at thirty days and one year. The authors concluded that a deferred PCI strategy for non culprit lesions should be the strategy in the setting of acute myocardial infarction with multivessel disease. Immediate multi vessel PCI may be associated with greater risk of mortality and stent thrombosis.
- Kornowski R, Mehran R, Dangas G, Nikolsky E, Assali A, Claessen BE, Gersh BJ, Wong SC, Witzenbichler B, Guagliumi G, Dudek D, Fahy M, Lansky AJ, Stone GW; HORIZONS-AMI Trial Investigators. Prognostic Impact of Staged Versus “One-Time” Multivessel Percutaneous Intervention in Acute Myocardial Infarction. Analysis From the HORIZONS-AMI (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction) Trial. J Am Coll Cardiol, 2011; 58:704-711.