Long term prognostic value of complete revascularization in patients with myocardial infarction and multivessel disease

A single center experience

Abstract

Introduction: multivessel (MV) disease is common in patients with myocardial infarction (MI), with worse prognostic during hospitalization and over a long term. Complete revascularization (CR) in STEMI reduces major cardiovascular events (MACE). This strategy is not clear in patients with NSTEMI. Objective: to determine the long-term prognosis of CR in patients with MI an MV disease. Methods: all MI admitted between 07/2016 and 12/2022 were analyzed. MV disease was considered when ≥70% stenosis was observed in a vessel other than the culprit (CV). CABG, inhospital deaths and loss in follow-up were excluded. CR was defined as revascularization for all feasible stenoses. MACE was analyzed during follow up. Results: from all the patients evaluated, 30.7% presented MV disease (n=189); 59.8% were STEMI and 40.2% NSTEMI. The sample was divided into two groups: CV revascularization vs CR. CR was performed in hospital in 42.8% and in 57.1% after discharge. Follow-up was made (33 months median) reporting a lower rate of MACE in the CR group: MI 6% vs 10.5% (p=0.2), stroke 0% vs 5.7% (p=0.02), PCI 10.7% vs 26.7%; (p=0.006), death 20.2% vs 38.1% (p=0.008) and combined events 31% vs 59% (p=0.0001). MACE-free survival was observed in CR group (p<0.001). CR was identified as an independent predictor variable of MACE during follow-up (OR 0.73 95% IC 0.65-0.88; p=0.001). Conclusion: CR in patients with MI and MV disease reduces mortality, revascularization, and MACE during the long term.