**5. Personalized choice of optimal revascularization strategy in patients with STEMI and MVCAD**

#### **5.1. Methods and statistical analysis**

Having recruited 327 consecutive patients, we carried out a single‐center registry study. Criteria of inclusion were (1) hospital admission within 12 h of STEMI onset requiring the performance of PPCI; (2) MVCAD defined as hemodynamically significant (≥70%) stenosis of ≥ 2 coronary arteries; (3) technical ability to perform PPCI. Criteria of exclusion were (1) acute heart fail‐ ure Killip class III‐IV, i.e., pulmonary edema and cardiogenic shock; (2) left main coronary artery stenosis ≥ 50%. Before PPCI, all patients received a loading dose of acetylsalicylic acid (250–500 mg) and clopidogrel (600 mg). Successful PPCI was defined as the reduction of ste‐ nosis to < 20% and a TIMI flow grade 3. After the PCI, all the patients received aspirin, statins, and clopidogrel during 1 year of follow‐up. Patients were divided into two groups: treated with MPS approach (n = 91) and treated with MSS approach (n = 236). The second stage of PCI in those who were treated with MSS approach was carried out 3–6 months after PPCI. After 12 months of follow‐up, both cardiac and noncardiac death, recurrent MI, and repeat coronary revascularization were defined as primary endpoints. Repeated revascularization was performed utilizing PCI after the baseline procedure due to the recurrent symptoms, recurrent MI, or significant ischemia at provocative testing. In patients treated with MSS approach, we defined only unplanned procedures as repeated revascularization. Follow‐up was conducted by outpatient visits or phone interviews.

We collected the data on age, gender, acute heart failure (Killip class), left ventricular ejection fraction, SYNTAX score, peripheral atherosclerosis (PA), past medical history of myocardial infarction or stroke, arterial hypertension, diabetes mellitus, MVCAD, and use of drug‐eluting stents.

Risk stratification models were obtained using stepwise logistic regression with the calculation of ROC curve and area under the curve (**Figures 1** and **2**).

Current Concept of Revascularization in STEMI Patients with Multivessel Coronary Artery Disease... http://dx.doi.org/10.5772/67884 31

**Figure 1.** ROC curve of the model calculated for MPS strategy.

**Figure 2.** ROC curve of the model calculated for MSS strategy.

We further developed an original calculator for choosing the optimal stenting strategy (Microsoft Excel).

#### **5.2. Results**

**4.4. Conclusions**

30 Interventional Cardiology

cularization in STEMI patients with MVCAD.

**with STEMI and MVCAD**

**5.1. Methods and statistical analysis**

by outpatient visits or phone interviews.

of ROC curve and area under the curve (**Figures 1** and **2**).

stents.

Both initial and residual SYNTAX score can predict death from all causes and/or MACE in patients with STEMI and MVCAD. Patients with high initial SYNTAX score tend to have a high residual SYNTAX score. Therefore, the patients with high initial SYNTAX score require com‐ plete revascularization and efficient antiplatelet therapy. Probably, it is required to develop a model of differentiated selection of the optimal revascularization strategy for STEMI patients to reduce the residual SYNTAX score to the end of in‐hospital period to ≤ 8 points using pri‐ mary multivessel stenting or staged PCIs. These results may be useful for risk stratification in patients with STEMI and MVCAD. In this context, in the next section of this chapter will be presented the relevant data of our own study—personalized choice of optimal strategy revas‐

**5. Personalized choice of optimal revascularization strategy in patients** 

Having recruited 327 consecutive patients, we carried out a single‐center registry study. Criteria of inclusion were (1) hospital admission within 12 h of STEMI onset requiring the performance of PPCI; (2) MVCAD defined as hemodynamically significant (≥70%) stenosis of ≥ 2 coronary arteries; (3) technical ability to perform PPCI. Criteria of exclusion were (1) acute heart fail‐ ure Killip class III‐IV, i.e., pulmonary edema and cardiogenic shock; (2) left main coronary artery stenosis ≥ 50%. Before PPCI, all patients received a loading dose of acetylsalicylic acid (250–500 mg) and clopidogrel (600 mg). Successful PPCI was defined as the reduction of ste‐ nosis to < 20% and a TIMI flow grade 3. After the PCI, all the patients received aspirin, statins, and clopidogrel during 1 year of follow‐up. Patients were divided into two groups: treated with MPS approach (n = 91) and treated with MSS approach (n = 236). The second stage of PCI in those who were treated with MSS approach was carried out 3–6 months after PPCI. After 12 months of follow‐up, both cardiac and noncardiac death, recurrent MI, and repeat coronary revascularization were defined as primary endpoints. Repeated revascularization was performed utilizing PCI after the baseline procedure due to the recurrent symptoms, recurrent MI, or significant ischemia at provocative testing. In patients treated with MSS approach, we defined only unplanned procedures as repeated revascularization. Follow‐up was conducted

We collected the data on age, gender, acute heart failure (Killip class), left ventricular ejection fraction, SYNTAX score, peripheral atherosclerosis (PA), past medical history of myocardial infarction or stroke, arterial hypertension, diabetes mellitus, MVCAD, and use of drug‐eluting

Risk stratification models were obtained using stepwise logistic regression with the calculation

#### *5.2.1. Baseline characteristics*

Patient groups did not have any significant differences in clinical or demographic character‐ istics (**Table 11**) as well as in angiographic features (**Table 12**) and characteristics of vascular access or implanted stents (**Table 13**).

Strikingly, there were no significant differences in outcomes between two revascularization strategies (**Table 14**).

Prognostic coefficients for each group of patients are presented in **Table 15**.

The values of prognostic coefficients were directly related to the risk of adverse outcome (**Table 15**). Past medical history of MI, severe coronary atherosclerosis (SYNTAX score ≥ 23), elderly age, and female gender showed significant predictive ability of an adverse outcome for patients treated with MPS, while past medical history of MI or stroke, PA, arterial hypertension, three‐vessel dis‐ ease, and the use of non‐DES were the predictors of an adverse outcome in those treated using MSS approach. The following clinical case represents an example of utilizing interactive calculator for the selection of the optimal revascularization strategy in a patient with STEMI and MVCAD.
