Timing of Complete Revascularization with Multivessel PCI for Myocardial Infarction

MULTISTARS AMI Investigators; Barbara E Stähli; Ferdinando Varbella; Axel Linke; Bettina Schwarz; Stephan B Felix; Moritz Seiffert; Rahel Kesterke; Peter Nordbeck; Bernhard Witzenbichler; Irene M. Lang; Mirjam Kessler; Christian Valina; Alban Dibra; Miklos Rohla; Marco Moccetti; Matteo Vercellino; Luise Gaede; Lorenz Bott-Flügel; Philipp Jakob; Julia Stehli; Alessandro Candreva; Christian Templin; Matthias Schindler; Manfred Wischnewsky; Greca Zanda; Giorgio Quadri; Norman Mangner; Aurel Toma; Giulia Magnani; Peter Clemmensen; Thomas F. Lüscher; Thomas Münzel; P Christian Schulze; Karl-Ludwig Laugwitz; Wolfgang Rottbauer; K. Huber; Franz Josef Neumann; Steffen Schneider; Franz Weidinger; Stephan Achenbach; Gert Richardt; Adnan Kastrati; Ian Ford; Willibald Maier; Frank Ruschitzka

doi:10.1056/NEJMoa2307823

Timing of Complete Revascularization with Multivessel PCI for Myocardial Infarction

MULTISTARS AMI Investigators, Barbara E Stähli^*, Ferdinando Varbella, Axel Linke, Bettina Schwarz, Stephan B Felix, Moritz Seiffert, Rahel Kesterke, Peter Nordbeck, Bernhard Witzenbichler, Irene M. Lang, Mirjam Kessler, Christian Valina, Alban Dibra, Miklos Rohla, Marco Moccetti, Matteo Vercellino, Luise Gaede, Lorenz Bott-Flügel, Philipp JakobJulia Stehli, Alessandro Candreva, Christian Templin, Matthias Schindler, Manfred Wischnewsky, Greca Zanda, Giorgio Quadri, Norman Mangner, Aurel Toma, Giulia Magnani, Peter Clemmensen, Thomas F. Lüscher, Thomas Münzel, P Christian Schulze, Karl-Ludwig Laugwitz, Wolfgang Rottbauer, K. Huber, Franz Josef Neumann, Steffen Schneider, Franz Weidinger, Stephan Achenbach, Gert Richardt, Adnan Kastrati, Ian Ford, Willibald Maier, Frank Ruschitzka

^*Corresponding author af dette arbejde

Medicinsk Afdeling

Publikation: Bidrag til tidsskrift › Artikel › Forskning › peer review

Abstract

BACKGROUND: In patients with ST-segment elevation myocardial infarction (STEMI) with multivessel coronary artery disease, the time at which complete revascularization of nonculprit lesions should be performed remains unknown.

METHODS: We performed an international, open-label, randomized, noninferiority trial at 37 sites in Europe. Patients in a hemodynamically stable condition who had STEMI and multivessel coronary artery disease were randomly assigned to undergo immediate multivessel percutaneous coronary intervention (PCI; immediate group) or PCI of the culprit lesion followed by staged multivessel PCI of nonculprit lesions within 19 to 45 days after the index procedure (staged group). The primary end point was a composite of death from any cause, nonfatal myocardial infarction, stroke, unplanned ischemia-driven revascularization, or hospitalization for heart failure at 1 year after randomization. The percentages of patients with a primary or secondary end-point event are provided as Kaplan-Meier estimates at 6 months and at 1 year.

RESULTS: We assigned 418 patients to undergo immediate multivessel PCI and 422 to undergo staged multivessel PCI. A primary end-point event occurred in 35 patients (8.5%) in the immediate group as compared with 68 patients (16.3%) in the staged group (risk ratio, 0.52; 95% confidence interval, 0.38 to 0.72; P<0.001 for noninferiority and P<0.001 for superiority). Nonfatal myocardial infarction and unplanned ischemia-driven revascularization occurred in 8 patients (2.0%) and 17 patients (4.1%), respectively, in the immediate group and in 22 patients (5.3%) and 39 patients (9.3%), respectively, in the staged group. The risk of death from any cause, the risk of stroke, and the risk of hospitalization for heart failure appeared to be similar in the two groups. A total of 104 patients in the immediate group and 145 patients in the staged group had a serious adverse event.

CONCLUSIONS: Among patients in hemodynamically stable condition with STEMI and multivessel coronary artery disease, immediate multivessel PCI was noninferior to staged multivessel PCI with respect to the risk of death from any cause, nonfatal myocardial infarction, stroke, unplanned ischemia-driven revascularization, or hospitalization for heart failure at 1 year. (Supported by Boston Scientific; MULTISTARS AMI ClinicalTrials.gov number, NCT03135275.).

Originalsprog	Engelsk
Sider (fra-til)	1368-1379
Antal sider	12
Tidsskrift	The New England journal of medicine
Vol/bind	389
Udgave nummer	15
Tidlig onlinedato	27 aug. 2023
DOI	https://doi.org/10.1056/NEJMoa2307823
Status	Udgivet - 12 okt. 2023

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Adgang til dokumentet

10.1056/NEJMoa2307823

Citationsformater

MULTISTARS AMI Investigators, Stähli, B. E., Varbella, F., Linke, A., Schwarz, B., Felix, S. B., Seiffert, M., Kesterke, R., Nordbeck, P., Witzenbichler, B., Lang, I. M., Kessler, M., Valina, C., Dibra, A., Rohla, M., Moccetti, M., Vercellino, M., Gaede, L., Bott-Flügel, L., ... Ruschitzka, F. (2023). Timing of Complete Revascularization with Multivessel PCI for Myocardial Infarction. The New England journal of medicine, 389(15), 1368-1379. https://doi.org/10.1056/NEJMoa2307823

@article{d0dff20ad70c49909e9b9613813ef379,

title = "Timing of Complete Revascularization with Multivessel PCI for Myocardial Infarction",

abstract = "BACKGROUND: In patients with ST-segment elevation myocardial infarction (STEMI) with multivessel coronary artery disease, the time at which complete revascularization of nonculprit lesions should be performed remains unknown.METHODS: We performed an international, open-label, randomized, noninferiority trial at 37 sites in Europe. Patients in a hemodynamically stable condition who had STEMI and multivessel coronary artery disease were randomly assigned to undergo immediate multivessel percutaneous coronary intervention (PCI; immediate group) or PCI of the culprit lesion followed by staged multivessel PCI of nonculprit lesions within 19 to 45 days after the index procedure (staged group). The primary end point was a composite of death from any cause, nonfatal myocardial infarction, stroke, unplanned ischemia-driven revascularization, or hospitalization for heart failure at 1 year after randomization. The percentages of patients with a primary or secondary end-point event are provided as Kaplan-Meier estimates at 6 months and at 1 year.RESULTS: We assigned 418 patients to undergo immediate multivessel PCI and 422 to undergo staged multivessel PCI. A primary end-point event occurred in 35 patients (8.5%) in the immediate group as compared with 68 patients (16.3%) in the staged group (risk ratio, 0.52; 95% confidence interval, 0.38 to 0.72; P<0.001 for noninferiority and P<0.001 for superiority). Nonfatal myocardial infarction and unplanned ischemia-driven revascularization occurred in 8 patients (2.0%) and 17 patients (4.1%), respectively, in the immediate group and in 22 patients (5.3%) and 39 patients (9.3%), respectively, in the staged group. The risk of death from any cause, the risk of stroke, and the risk of hospitalization for heart failure appeared to be similar in the two groups. A total of 104 patients in the immediate group and 145 patients in the staged group had a serious adverse event.CONCLUSIONS: Among patients in hemodynamically stable condition with STEMI and multivessel coronary artery disease, immediate multivessel PCI was noninferior to staged multivessel PCI with respect to the risk of death from any cause, nonfatal myocardial infarction, stroke, unplanned ischemia-driven revascularization, or hospitalization for heart failure at 1 year. (Supported by Boston Scientific; MULTISTARS AMI ClinicalTrials.gov number, NCT03135275.).",

author = "{MULTISTARS AMI Investigators} and St{\"a}hli, {Barbara E} and Ferdinando Varbella and Axel Linke and Bettina Schwarz and Felix, {Stephan B} and Moritz Seiffert and Rahel Kesterke and Peter Nordbeck and Bernhard Witzenbichler and Lang, {Irene M.} and Mirjam Kessler and Christian Valina and Alban Dibra and Miklos Rohla and Marco Moccetti and Matteo Vercellino and Luise Gaede and Lorenz Bott-Fl{\"u}gel and Philipp Jakob and Julia Stehli and Alessandro Candreva and Christian Templin and Matthias Schindler and Manfred Wischnewsky and Greca Zanda and Giorgio Quadri and Norman Mangner and Aurel Toma and Giulia Magnani and Peter Clemmensen and L{\"u}scher, {Thomas F.} and Thomas M{\"u}nzel and Schulze, {P Christian} and Karl-Ludwig Laugwitz and Wolfgang Rottbauer and K. Huber and Neumann, {Franz Josef} and Steffen Schneider and Franz Weidinger and Stephan Achenbach and Gert Richardt and Adnan Kastrati and Ian Ford and Willibald Maier and Frank Ruschitzka",

note = "Copyright {\textcopyright} 2023 Massachusetts Medical Society.",

year = "2023",

month = oct,

day = "12",

doi = "10.1056/NEJMoa2307823",

language = "English",

volume = "389",

pages = "1368--1379",

journal = "The New England journal of medicine",

issn = "0028-4793",

publisher = "Massachussetts Medical Society",

number = "15",

}

MULTISTARS AMI Investigators, Stähli, BE, Varbella, F, Linke, A, Schwarz, B, Felix, SB, Seiffert, M, Kesterke, R, Nordbeck, P, Witzenbichler, B, Lang, IM, Kessler, M, Valina, C, Dibra, A, Rohla, M, Moccetti, M, Vercellino, M, Gaede, L, Bott-Flügel, L, Jakob, P, Stehli, J, Candreva, A, Templin, C, Schindler, M, Wischnewsky, M, Zanda, G, Quadri, G, Mangner, N, Toma, A, Magnani, G, Clemmensen, P, Lüscher, TF, Münzel, T, Schulze, PC, Laugwitz, K-L, Rottbauer, W, Huber, K, Neumann, FJ, Schneider, S, Weidinger, F, Achenbach, S, Richardt, G, Kastrati, A, Ford, I, Maier, W & Ruschitzka, F 2023, 'Timing of Complete Revascularization with Multivessel PCI for Myocardial Infarction', The New England journal of medicine, bind 389, nr. 15, s. 1368-1379. https://doi.org/10.1056/NEJMoa2307823

TY - JOUR

T1 - Timing of Complete Revascularization with Multivessel PCI for Myocardial Infarction

AU - MULTISTARS AMI Investigators

AU - Stähli, Barbara E

AU - Varbella, Ferdinando

AU - Linke, Axel

AU - Schwarz, Bettina

AU - Felix, Stephan B

AU - Seiffert, Moritz

AU - Kesterke, Rahel

AU - Nordbeck, Peter

AU - Witzenbichler, Bernhard

AU - Lang, Irene M.

AU - Kessler, Mirjam

AU - Valina, Christian

AU - Dibra, Alban

AU - Rohla, Miklos

AU - Moccetti, Marco

AU - Vercellino, Matteo

AU - Gaede, Luise

AU - Bott-Flügel, Lorenz

AU - Jakob, Philipp

AU - Stehli, Julia

AU - Candreva, Alessandro

AU - Templin, Christian

AU - Schindler, Matthias

AU - Wischnewsky, Manfred

AU - Zanda, Greca

AU - Quadri, Giorgio

AU - Mangner, Norman

AU - Toma, Aurel

AU - Magnani, Giulia

AU - Clemmensen, Peter

AU - Lüscher, Thomas F.

AU - Münzel, Thomas

AU - Schulze, P Christian

AU - Laugwitz, Karl-Ludwig

AU - Rottbauer, Wolfgang

AU - Huber, K.

AU - Neumann, Franz Josef

AU - Schneider, Steffen

AU - Weidinger, Franz

AU - Achenbach, Stephan

AU - Richardt, Gert

AU - Kastrati, Adnan

AU - Ford, Ian

AU - Maier, Willibald

AU - Ruschitzka, Frank

PY - 2023/10/12

Y1 - 2023/10/12

N2 - BACKGROUND: In patients with ST-segment elevation myocardial infarction (STEMI) with multivessel coronary artery disease, the time at which complete revascularization of nonculprit lesions should be performed remains unknown.METHODS: We performed an international, open-label, randomized, noninferiority trial at 37 sites in Europe. Patients in a hemodynamically stable condition who had STEMI and multivessel coronary artery disease were randomly assigned to undergo immediate multivessel percutaneous coronary intervention (PCI; immediate group) or PCI of the culprit lesion followed by staged multivessel PCI of nonculprit lesions within 19 to 45 days after the index procedure (staged group). The primary end point was a composite of death from any cause, nonfatal myocardial infarction, stroke, unplanned ischemia-driven revascularization, or hospitalization for heart failure at 1 year after randomization. The percentages of patients with a primary or secondary end-point event are provided as Kaplan-Meier estimates at 6 months and at 1 year.RESULTS: We assigned 418 patients to undergo immediate multivessel PCI and 422 to undergo staged multivessel PCI. A primary end-point event occurred in 35 patients (8.5%) in the immediate group as compared with 68 patients (16.3%) in the staged group (risk ratio, 0.52; 95% confidence interval, 0.38 to 0.72; P<0.001 for noninferiority and P<0.001 for superiority). Nonfatal myocardial infarction and unplanned ischemia-driven revascularization occurred in 8 patients (2.0%) and 17 patients (4.1%), respectively, in the immediate group and in 22 patients (5.3%) and 39 patients (9.3%), respectively, in the staged group. The risk of death from any cause, the risk of stroke, and the risk of hospitalization for heart failure appeared to be similar in the two groups. A total of 104 patients in the immediate group and 145 patients in the staged group had a serious adverse event.CONCLUSIONS: Among patients in hemodynamically stable condition with STEMI and multivessel coronary artery disease, immediate multivessel PCI was noninferior to staged multivessel PCI with respect to the risk of death from any cause, nonfatal myocardial infarction, stroke, unplanned ischemia-driven revascularization, or hospitalization for heart failure at 1 year. (Supported by Boston Scientific; MULTISTARS AMI ClinicalTrials.gov number, NCT03135275.).

AB - BACKGROUND: In patients with ST-segment elevation myocardial infarction (STEMI) with multivessel coronary artery disease, the time at which complete revascularization of nonculprit lesions should be performed remains unknown.METHODS: We performed an international, open-label, randomized, noninferiority trial at 37 sites in Europe. Patients in a hemodynamically stable condition who had STEMI and multivessel coronary artery disease were randomly assigned to undergo immediate multivessel percutaneous coronary intervention (PCI; immediate group) or PCI of the culprit lesion followed by staged multivessel PCI of nonculprit lesions within 19 to 45 days after the index procedure (staged group). The primary end point was a composite of death from any cause, nonfatal myocardial infarction, stroke, unplanned ischemia-driven revascularization, or hospitalization for heart failure at 1 year after randomization. The percentages of patients with a primary or secondary end-point event are provided as Kaplan-Meier estimates at 6 months and at 1 year.RESULTS: We assigned 418 patients to undergo immediate multivessel PCI and 422 to undergo staged multivessel PCI. A primary end-point event occurred in 35 patients (8.5%) in the immediate group as compared with 68 patients (16.3%) in the staged group (risk ratio, 0.52; 95% confidence interval, 0.38 to 0.72; P<0.001 for noninferiority and P<0.001 for superiority). Nonfatal myocardial infarction and unplanned ischemia-driven revascularization occurred in 8 patients (2.0%) and 17 patients (4.1%), respectively, in the immediate group and in 22 patients (5.3%) and 39 patients (9.3%), respectively, in the staged group. The risk of death from any cause, the risk of stroke, and the risk of hospitalization for heart failure appeared to be similar in the two groups. A total of 104 patients in the immediate group and 145 patients in the staged group had a serious adverse event.CONCLUSIONS: Among patients in hemodynamically stable condition with STEMI and multivessel coronary artery disease, immediate multivessel PCI was noninferior to staged multivessel PCI with respect to the risk of death from any cause, nonfatal myocardial infarction, stroke, unplanned ischemia-driven revascularization, or hospitalization for heart failure at 1 year. (Supported by Boston Scientific; MULTISTARS AMI ClinicalTrials.gov number, NCT03135275.).

U2 - 10.1056/NEJMoa2307823

DO - 10.1056/NEJMoa2307823

M3 - Article

C2 - 37634190

SN - 0028-4793

VL - 389

SP - 1368

EP - 1379

JO - The New England journal of medicine

JF - The New England journal of medicine

IS - 15

ER -

Timing of Complete Revascularization with Multivessel PCI for Myocardial Infarction

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