https://doi.org/10.55788/39982dad
The MULTISTARS AMI trial (NCT03135275) assessed whether immediate multivessel PCI was non-inferior to staged PCI (within 19 to 45 days) in haemodynamically stable patients with STEMI and MVD following successful PCI of the culprit artery [1]. The study randomised 840 participants 1:1 to immediate PCI of non-culprit lesions or staged PCI of non-culprit lesions. The primary outcome was a composite of all-cause death, non-fatal MI, stroke, unplanned ischaemia-driven revascularisation, or hospitalisation for heart failure at 52 weeks. Prof. Barbara Stähli (University of Zürich, Switzerland) presented the primary findings.
Immediate PCI was non-inferior to staged PCI (RR 0.52; 95% CI 0.38–0.72; Pnon-inferiority<0.0001). In fact, the risk for primary outcome events was significantly lower in the immediate PCI group (P=0.0004). Non-fatal MI (RR 0.36; 95% CI 0.16–0.80) and unplanned ischaemia-driven revascularisation (RR 0.42; 95% CI 0.24–0.74) appeared to occur more frequently in the staged PCI arm than in the immediate PCI arm. The results were consistent across subgroups. “Immediate PCI was non-inferior to staged PCI in patients with STEMI and MVD who underwent a successful primary PCI,” concluded Prof. Stähli.
Prof. Robert Byrne (RCSI University, Ireland), discussant of the trial, pointed out that the observed difference in MI rates between the 2 study arms was not due to an increase of spontaneous (type 1) MI in the staged PCI group but related to a higher number of procedural MI in the staged PCI group (n=12 vs n=0). “This raises some questions in relation to ascertainment bias in the immediate PCI group, where it can be difficult to detect periprocedural MI,” he argued. “Therefore, the results of the MULTISTARS AMI trial provide evidence, but not strong evidence, of benefit with routine immediate PCI during the index procedure as compared with staged outpatient PCI.”
- Stähli B, et al. Multivessel immediate versus staged revascularization in acute myocardial infarction (MULTISTARS AMI): a randomized study of immediate versus staged revascularization after primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. Hot Line Session 6, ESC Congress 2023, 25–28 August, Amsterdam, the Netherlands.
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Table of Contents: ESC 2023
Featured articles
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2023 ESC Guidelines & Updates
Heart failure: the 2023 update
Guidelines for Acute Coronary Syndrome
Guidelines for the management of cardiomyopathies
Cardiovascular disease and diabetes: new guidelines
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Trial Updates in Heart Failure
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CRT upgrade benefits patients with HFrEF and an ICD
Catheter ablation saves lives in end-stage HF with AF
Meta-analysis: Does FCM improve clinical outcomes in HF?
HEART-FID: Is intravenous ferric carboxymaltose helpful in HFrEF with iron deficiency?
Natriuresis-guided diuretic therapy to facilitate decongestion in acute HF
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Key Research on Prevention
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Finetuning Antiplatelet and Anticoagulation Therapy
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Results of FRAIL-AF trial suggest increased bleeding risk with DOACs
The optimal duration of anticoagulation therapy in cancer patients with DVT
DAPT or clopidogrel monotherapy after stenting in high-risk East-Asian patients?
Assets for ACS and PCI Optimisation
Immediate or staged revascularisation in STEMI plus multivessel disease?
Lp(a) and cardiovascular events: which test is the best?
No benefit of extracorporeal life support in MI plus cardiogenic shock
Functional revascularisation outperforms culprit-only strategy in older MI patients
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