One-time complete revascularization vs. staged PCI in multivessel Coronary Artery Disease during a pharmaco-invasive STEMI strategy

Abstract

The optimal timing of complete revascularization in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease (MVD) undergoing a pharmaco-invasive strategy remains uncertain. To compare one-time complete revascularization during the index PCI with staged PCI regarding clinical outcomes, resource utilization, contrast-induced nephropathy (CIN), and short-term major adverse cardiovascular events (MACE) in STEMI patients with MVD treated using a pharmaco-invasive strategy. This prospective randomized comparative study enrolled 112 adult patients with acute STEMI and MVD who underwent successful fibrinolysis followed by PCI. Patients were randomized to one-time complete revascularization during the index procedure (Group A, n = 56) or culprit-only PCI followed by staged non-culprit PCI within one month (Group B, n = 56). Outcomes included total hospitalization time, total treatment costs, CIN within 72 h, echocardiographic parameters, and 3-month MACE. Baseline characteristics and reperfusion timelines were comparable between groups. One-time complete revascularization significantly reduced total hospitalization time (2.9 ± 1.1 vs. 5.0 ± 1.4 days; P < 0.0001) and total treatment costs (median 46 514 vs. 70 517 EGP; P < 0.001). Left ventricular ejection fraction and serum creatinine were similar between groups at baseline and at 3 months. Wall motion score index was significantly lower in the one-time revascularization group at baseline (1.7 ± 0.3 vs. 1.8 ± 0.17; P = 0.032) and at 3 months (1.4 ± 0.28 vs. 1.5 ± 0.24; P = 0.045). Angina-related hospitalization at 3 months occurred less frequently in the one-time revascularization group (14.3 vs. 53.6%; P < 0.001), while other in-hospital complications and MACE components did not differ significantly between groups. In patients with STEMI and multivessel coronary artery disease treated with a pharmaco-invasive strategy, one-time complete revascularization reduced hospitalization duration, healthcare costs, and angina-related readmissions without increasing short-term adverse cardiovascular events. These findings support one-time complete revascularization as an effective and safe strategy in appropriately selected patients.