Coronary revascularization in patients with ST-segment elevation myocardial infarction and multivessel disease: 2-year follow-up from a large multicenter registry.

Abstract

Introduction: Multivessel coronary artery disease (MVD) occurs in one‑third of patients with ST‑segment elevation myocardial infarction (STEMI) who undergo primary percutaneous coronary intervention (pPCI). However, long‑term prognosis and readmission rates in this high‑risk group remain unclear.

Objectives: We aimed to evaluate the long‑term risk of cardiovascular events and readmissions in STEMI patients with MVD.

Patients and methods: This prospective observational study included 1513 patients enrolled in the Silesian Cardiovascular Database between 2017 and 2020. We analyzed demographic, clinical, and angiographic characteristics along with prognosis during 2‑year follow‑up.

Results: A total of 439 patients with MVD were identified in the registry. Among them, 2‑vessel disease (2‑VD) was detected in 329 patients (74.9%) and 3‑vessel disease (3‑VD) in 110 (25.1%). During 2‑year follow‑up, overall survival and the incidence of major adverse cardiovascular events (death, MI, stroke) were similar in both groups. In multivariable analyses, previous MI (hazard ratio [HR], 1.63; 95% CI, 1.01-2.63; P = 0.04) and the left main coronary artery as the infarct‑related artery (IRA; HR, 3.22; 95% CI, 1-10.38; P = 0.049) increased the risk of unplanned cardiac readmissions, whereas clopidogrel use (HR, 1.45; 95% CI, 1.07-1.95; P = 0.01) increased the risk of all‑cause readmissions. PCI of a non‑IRA during the index hospitalization was associated with a lower risk of both unplanned cardiac (HR, 0.61; 95% CI, 0.42-0.9; P = 0.01) and all‑cause (HR, 0.61; 95% CI, 0.46-0.82; P = 0.001) readmissions.

Conclusions: Two‑year overall survival and event‑free survival were similar in STEMI patients with 2‑VD and 3‑VD. The use of more potent antiplatelets instead of clopidogrel as well as non‑IRA revascularization during the index hospitalization appear to be important for minimizing readmission rates.