Comparison of Culprit-only versus Multi-vessel Percutaneous Coronary Intervention with 2nd GenerationDrug- Eluting Stent in ST-elevation Myocardial Infarction: Data from INTERSTELLAR cohort

초록

Objectives We compared the effect of culprit-only and multi-vessel disease percutaneous coronary intervention (MVD-PCI) with 2nd generation drug eluting stent (DES) in ST-segment elevation myocardial infarction (STEMI) with multivessel disease (MVD) Methods From 2009 to 2014, a total of 1541consecutive patients with STEMI underwent primary PCIwere analyzed retrospectively.Of all patients, 559 patients (zotarolimus-eluting stent: 32%, everolimus-eluting stent: 29%, biolimus-eluting stent: 10%, others 29%) with MVDwere chosen and divided into culprit only PCI (n=270, 48%) and MVD-PCI (n=289, 52%). In addition, MVD-PCI was classified intosimultaneous PCIat index procedure (n=210, 38%) and staged PCI (n=79, 14%) according to the way of PCI.Primary endpoint was cardiovascular (CV) death. The secondary endpoints was major adverse cardiac and cerebrovascular events (MACCE) includingCV death, MI, target vessel failure (TVF), admission from heart failure and stroke. Results Over a mean follow-up period of 23±19 months, there were 69 (12%) CV death and 114 (20%) MACCE.Compared with culprit only PCI,MVD-PCI had a numerically lower CV death rate(10.1% vs. 14.7%, HR 0.64, p=0.07, CI 0.399~1.041) and significantly lower MACCE rate(17.5% vs. 23.4%, HR 0.66, p=0.03, CI 0.458~0.961). Of MVD-PCIpatients, staged PCI showed numerically lower CV death rate (5.1% vs. 11.9%, HR 0.40, p=0.09, CI 0.141~1.167) and MACCE (12.7% vs. 19.0%, HR 0.63, p=0.20, CI 0.319~1.277) compared to simultaneous PCI. Conclusions In 2nd generation DES era, MVD-PCIwas associated with better longterm outcomes compared to culprit-only PCIin patients with STEMI with MVD.