In-hospital Versus After-discharge Complete Revascularization

STEMI patients with mutivessel disease are, after successful primary angioplasty, randomized 1:1 ratio to either in-hospital complete revascularization or after-discharge complete revascularization strategy.

Eligible non-culprit coronary arteries must be >2.0 mm in diameter and at the discretion of the operator suitable for PCI. Only arteries with angiographically stenoses ≥70% or between ≥50% and <70 in proximal segments can be randomized.

Patients in the in-hospital revascularization group will undergo to non-culprit percutaneous coronary intervention (PCI) at least 24 hours after ST-segment elevation myocardial infarction. On the other hand, patients in the after-discharge group will undergo to non-culprit PCI within 4-6 weeks after STEMI.

Inclusion criteria

• Acute onset of chest pain <12 hours duration.
• ST-segment elevation ≥ 0.1 millivolt in ≥ 2 contiguous leads, signs of a true posterior infarction or documented newly developed left bundle branch block.
• Culprit lesion in a major native vessel, with successful primary PCI.
• Presence of at least one non-culprit lesion more than or equal to 70% of stenosis in a vessel more than 2mm of diameter or more than or equal to 50% stenosis in proximal segments.
• The patient is able to give written consent for participation in the study.

Exclusion criteria

• Pregnancy.
• Significant left main stenosis.
• Stent thrombosis.
• Chronic total occlusion.
• Severe stenosis of non-culprit vessels with distal flow less than TIMI3.
• Significant non-culprit stenosis no candidate to revascularization.
• Presence of valvulopathy candidate for cardiac surgery.
• Cardiogenic shock status at admission.
• The patient is not able to give written consent for participation in the study.