Keshav Budhathoki*, Shyam raj Regmi, Sudhir Regmi, Bishnu Mani Dhital, Ananda GC3 and Sabina Sedhai
Background: A significant proportion of patients with ST-segment elevation myocardial infarction have multivessel coronary artery disease. Although several trials have compared complete with culprit-only revascularization in ST-segment elevation MI, it remains unclear whether complete revascularization may lead to improvement in hard endpoints (death and MI). Earlier trials showed that it is harmful to undergo complete revascularization in hemodynamically stable patient. Later on with the advancement of the time, these days, it is said that complete revascularization either index or staged PCI is superior to culprit only revascularization in hemodynamically stable patient.
Methods: This research was a prospective observational study of 130 cases conducted at Chitwan Medical College and Teaching Hospital, Chitwan. This study included all the consent given patients who presented with acute ST elevation myocardial infarction and underwent coronary angiography and found to have significant multivessel lesion from December, 2018 to May, 2021.
Results: Among 130 cases, 58 (44.6%) cases underwent complete revascularization and 72 (55.4%) cases underwent culprit only revascularization. Coronary angiogram showed double vessel disease in 92 (70.8%) and triple vessel disease 38 (29.2%). Compared with culprit only revascularization, complete revascularization significantly reduced the risk for death, MI and dreadful arrhythmias VT/VF (RR: 0.062; 95% CI: 0.002 to 0.122; p value 0.045) without much increase in CIN or major GI bleeding.
Conclusion: Complete revascularizations with pPCI during index procedure significantly reduce the combined endpoint of death, MI and dreadful arrhythmia without much difference in CIN and major GI bleed.
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