Revascularization Strategy Fails To Show Noninferiority In Stemi Patients

Multivessel coronary artery illness - erstwhile astatine slightest 2 coronary arteries are blocked - affects almost half of patients who person STEMI, a type of bosom attack. ESC Guidelines urge complete revascularisation pinch PCI successful patients pinch STEMI and multivessel disease, involving treating nan blocked artery that caused nan bosom onslaught (culprit lesion) positive different affected vessels (non-culprit lesions).2

Explaining nan purpose of nan OPTION-STEMI trial, its Principal Investigator, Professor Youngkeun Ahn from Chonnam National University Hospital, Gwangju, South Korea, stated, "We compared contiguous complete revascularisation pinch PCI for nan culprit and non-culprit lesions during nan aforesaid process pinch staged complete revascularisation, wherever PCI for non-culprit lesions took spot connected different time during nan aforesaid hospitalisation. We included a wide organization of patients pinch STEMI and multivessel coronary artery disease."

The OPTION-STEMI proceedings was an investigator-initiated, open-label, noninferiority randomised proceedings conducted successful 14 sites successful South Korea. Patients were eligible if they presented pinch STEMI and multivessel coronary artery illness and underwent successful PCI for a culprit artery.

Patients were randomised 1:1 to either contiguous complete revascularisation pinch simultaneous PCI for nan culprit and non-culprit lesions aliases staged complete revascularisation that included PCI for non-culprit lesions connected different time during nan scale hospitalisation. The superior endpoint was nan composite of all-cause death, non-fatal MI and immoderate unplanned revascularisation astatine 1 year.

A full of 994 patients underwent randomisation. Median property was 66 years and 79% of patients were men. One-third (33%) of patients presented pinch Killip people II aliases III, indicating signs of bosom failure. The median magnitude of infirmary enactment was 4 days successful nan contiguous group and 5 days successful nan staged group. In nan staged group, nan median clip to nan 2nd process was 3 days.

At 1 year, nan superior endpoint of death, MI and immoderate unplanned revascularisation occurred successful 13.1% of patients successful nan contiguous group and 10.8% successful nan staged group (hazard ratio [HR] 1.24; 95% assurance interval [CI] 0.86 to 1.79; p for noninferiority=0.24), pinch noninferiority not established.

Prespecified subgroup analyses suggested heterogeneity successful nan curen effect according to nan Killip class. Immediate complete revascularisation was associated pinch much harm successful patients pinch signs of bosom nonaccomplishment (Killip people ≥II: HR 1.79; 95% CI 1.05 to 3.05) than successful patients without bosom nonaccomplishment signs (Killip people I: HR 0.84; 95% CI 0.50 to 1.41; p for interaction=0.04).

Regarding secondary endpoints, non-fatal MI occurred successful 3.9% of nan patients successful nan contiguous group and 5.1% successful nan staged group (HR 0.77; 95% CI 0.42 to 1.39), while decease occurred successful 7.5% vs. 5.3% of patients, respectively (HR 1.44; 95% CI 0.87 to 2.38).