P5609Complete revascularisation in STEMI patients with multi-vessel disease: inpatient versus outpatient staged revascularisation results in similar clinical outcomes

Abstract

Background: About 50% of patients presenting with STEMI undergoing primary PCI have multivessel coronary artery disease which is associated with poorer out-comes compared to single vessel disease. Improved prognosis has been shown in randomized controlled trials when bystander disease is treated at time of the primary PCI compared to culprit only treatment. Whilst there is general consensus on the above; currently neither guidelines nor evidence exist regarding the optimal time for complete revascularisation (inpatients or outpatients staged). Purpose: The aim of the study is to compare clinical outcomes in STEMI patients with multi-vessel coronary artery disease who underwent complete revasculari-sation as inpatients respect to patients who had staged PCI within six weeks. Methods: This was an observational cohort study of 497 patients with multi-vessel disease who underwent primary PCI from 2012 to 2017. Patients with previous CABG and cardiogenic shock were excluded. Patients were divided into 2 groups according to whether they underwent complete inpatient or outpatient staged PCI. The primary outcome was major adverse cardiac events (all cause mortality, myocardial infarction, target vessel revascularisation). 317 (68.76%) pa-tients underwent complete inpatient revascularisation and 144 patients (31,23%) had outpatient PCI (at a mean of 53 days post discharge). Of the IP complete revascularisation group, 248 patients (53,79%) underwent complete revasculari-sation during the index procedure whilst 69 (14,96%) patients underwent inpatient bystander PCI in a 2nd separate procedure. Results: There was no significant difference between the groups in terms of baseline (age, sex, smoking history, diabetes, hypertension or hypercholes-terolemia) or procedural characteristics. On Kaplan-Meier analysis there was no significant difference in MACE between the inpatient and outpatient cohorts (p-value 0.62). Age-adjusted Cox analysis demonstrated no difference in outcomes between inpatient and outpatient procedures (HR 1.40 [95% CI 0.87-1.92)), which persisted after multivariate adjustment ((HR 1.21 [95% CI 0.72-1.96). [Figure Presented] Conclusion(s): According to the literature, improved prognosis has been shown in randomized controlled trials when bystander disease is treated at time of the primary PCI compared to culprit only treatment. In this study we observed that the timing of bystander PCI after STEMI did not appear to have an effect on car-diovascular outcomes. Our results suggest that patients with multivessel disease could be promptly discharged and have bystander PCI as an outpatient which could have a significant impact on hospital length of stay and reduce costs.