MULTIVESSEL STENTING VERSUS STAGED REVASCULARIZATION WITH SECOND GENERATION DRUG ELUTING STENTS IN ST-ELEVATION MYOCARDIAL INFARCTION PATIENTS: RESULTS OF RANDOMIZED TRIAL
Aim: the assessment of the 12-month results of the two strategies after percutaneous coronary intervention (PCI) with implantation of zotarolimus-eluting stents (ZES) in multivesseldisease patients with ST-elevationmyocardial infarction (STEMI) in a randomized trial (NCT01781715). Methods: from 2013 to 2015 136 STEMI patients after primary PCI was included. Inclusion criteria were as follows: (1) STEMI <12 h; (2) Multivessel coronary disease; (3) The implantation of the second generation ZES; (4) Signed informed consent to participate in the trial; Exclusion criteria were: (1) Left main coronary artery stenosis > 50%; (2) Severe acute heart failure (Killip III-IV); (3) A history of stent thrombosis; Patients were randomized in two groups: (1) Multivessel stenting (MS) within the primary PCI (n = 67); (2) Staged PCI within the hospital period (10,1 ± 5,1 days), (n = 69).Adverse cardiovascular events (death, myocardial infarction (MI), re unplanned revascularization, stent thrombosis and the combined endpoint) wereevaluated for 30 days and 12 months.. Results: the average age in the total study sample of patients (n = 136) was 59 ± 10.6 (31-88) years, dominated by male patients (n = 92, 67.2%). The mean left ventricular ejection fraction was 51.2 ± 8.3%. One in five patients (n = 30, 22.1%) suffered from diabetes, one in four (n = 33, 24.3%) had multifocal atherosclerosis. Acute heart failure (Killip II) observed in 13% of patients. About half of the patients (n = 63, 46.3%) had three-vessel coronary disease with an average value of SYNTAX score 18.9 ± 7.5 points. The average number of implanted ZES was 2.7 ± 0.7, the average length of stented segment 57.8 ± 14.6 mm, an average diameter 3.3 ± 0.5 mm. The groups of patients were comparable for all baseline demographic, clinical and angiographic parameters. Over the 12 months of observation was not received significant differences in frequency of adverse cardiovascular events among the groups: death from all causes 3% and 2.9%, reinfarction 7.5% and 2.9%, re unplanned revascularization 3% and 2.9%, stent thrombosis 5.9% and 2.9%, the combined endpoint (death + MI + unplanned revascularization) 5.9% and 4.3% in the MS group and staged PCI group, respectively (p> 0.05).