ABC | Volume 115, Nº2, August 2020

Original Article Complete Revascularization Versus Treatment of the Culprit Artery Only in ST Elevation Myocardial Infarction: A Multicenter Registry Julia Cremona Cadore, 1 Mariana Vargas Furtado, 2 Rogério Tumelero, 3 Alexandre Tognon, 3 Ana Maria Krepsky, 1 Denis Cadore, 3 Karen Brasil Ruschel, 2 Julia Caldas Bedin, 4 Thais Conte, 4 Carisi Anne Polanczyk 5 Universidade Federal do Rio Grande do Sul - PPG Ciências Cardiovasculares: Cardiologia, 1 Porto Alegre, RS - Brazil Hospital de Clínicas de Porto Alegre - Instituto de Avaliação de Tecnologia em Saúde, 2 Porto Alegre, RS - Brazil Universidade de Passo Fundo, 3 Passo Fundo, RS - Brazil Universidade Federal do Rio Grande do Sul - Faculdade de Medicina, 4 Porto Alegre, RS - Brazil Hospital de Clínicas de Porto Alegre, 5 Porto Alegre, RS – Brazil Mailing Address: Carisi Anne Polanczyk • Hospital de Clínicas de Porto Alegre - Instituto de Avaliação de Tecnologia em Saúde - Rua Ramiro Barcelos, 2350. Postal Code 90035-903, Porto Alegre, RS – Brazil E-mail: carisi.anne@gmail.com Manuscript received November 13, 2018, revised manuscript June 14, 2019, accepted August 18, 2019 DOI: https://doi.org/10.36660/abc.20180346 Abstract Background: Data on the management and prognosis of patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease are limited in Brazil, showing that the available revascularization strategies should be investigated Objective: To assess the outcomes of complete revascularization versus treatment of the culprit artery only in patients with STEMI and multivessel disease. Methods: A prospective cohort study was conducted at two medical centers in southern Brazil with a 1-year follow-up after the index procedure. The primary outcome was a composite of cardiac death, reinfarction, or recurrent angina, while the secondary outcome was stroke, nonfatal cardiac arrest, major bleeding, or need for reintervention. The probability of outcomes occurring was compared between the groups using binary logistic regression. A p-value < 0.05 was considered statistically significant. Results: Eighty-five patients were included. Their mean age was 62±12 years, and 61 (71.8%) were male. Fifty-eight (68.2%) were treated with complete revascularization and 27 (31.8%) with incomplete revascularization. The chance of both the primary and secondary outcomes occurring was significantly greater among patients treated with incomplete revascularization when compared to those treated with complete revascularization (odds ratio [OR] 5.1, 95% confidence interval [CI] 1.6-16.1 vs. OR 5.2, 95% CI 1.2-22.9, respectively), as well as cardiac death (OR 6.4, 95% CI 1.2-35.3). Conclusion: Registry data from two centers in southern Brazil demonstrate that the complete revascularization strategy is associated with a significant reduction in primary and secondary outcomes in a 1-year follow-up when compared to the incomplete revascularization strategy (Arq Bras Cardiol. 2020; 115(2):229-237) Keywords: ST Elevation Myocardial Infarction/mortality, Cohort Studies; Hemodynamic; Death Certificates; Angina Pectoris; Stroke; Heart Arrest; Death Certificates; Angina Pectoris; Stroke; Heart Arrest; Percutaneous Coronary Interventions. Introduction ST-segment elevation myocardial infarction (STEMI) is an extremely relevant public health issue 1 with a high mortality rate if not properly treated. 2 Approximately 50% of patients present with multivessel coronary artery disease (CAD), 3-4 in which case prognosis is even more unfavorable. 5 Therapeutic options for this complex group of patients with STEMI and multivessel disease include primary percutaneous coronary intervention (PCI) in the culprit artery and PCI in the other stenoses only for spontaneous ischemia or risk findings in noninvasive tests (incomplete revascularization – IR); multivessel PCI at the time of primary PCI (complete revascularization – CR); primary PCI in the culprit artery and staged approach of the other stenoses (staged CR). Initial studies showed conflicting results. 6 The PRAMI (Preventive Angioplasty in Acute Myocardial Infarction) study, however, led to a paradigm shift as it demonstrated the benefit of multivessel PCI compared to culprit-artery-only PCI. 7 Other trials reinforced the hypothesis that a CR strategy could be beneficial and safe in selected patients with STEMI. 8-10 229