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Multivessel PCI on top of culprit lesion revascularization?. No way!. Major issues. How do you define complete revascularization in multivessel disease (MVD)? What is the risk-benefit balance of culprit vs multivessel PCI in stable MVD?

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major issues
Major issues
  • How do you define complete revascularization in multivessel disease (MVD)?
  • What is the risk-benefit balance of culprit vs multivessel PCI in stable MVD?
  • What is the risk-benefit balance of culprit vs multivessel PCI in acute MVD?
major issues7
Major issues
  • How do you define complete revascularization in multivessel disease (MVD)?
  • What is the risk-benefit balance of culprit vs multivessel PCI in stable MVD?
  • What is the risk-benefit balance of culprit vs multivessel PCI in acute MVD?
defining revascularization
Defining revascularization
  • Anatomically complete: PCI of every occluded or stenotic epicardial vessel
  • Functionally complete: PCI of every occluded or stenotic epicardial vessel of adequate size and supplying a zone of viable myocardium
  • Incomplete (culprit only): PCI of occluded or stenotic epicardial vessel identified by clinical judgement as responsible for signs/symptoms of ischemia
  • Incomplete (truly): everything else
hazards of multivessel stenting11
Hazards of multivessel stenting

Orlic et al, JACC 2004

major issues12
Major issues
  • How do you define complete revascularization in multivessel disease (MVD)?
  • What is the risk-benefit balance of culprit vs multivessel PCI in stable MVD?
  • What is the risk-benefit balance of culprit vs multivessel PCI in acute MVD?
major issues22
Major issues
  • How do you define complete revascularization in multivessel disease (MVD)?
  • What is the risk-benefit balance of culprit vs multivessel PCI in stable MVD?
  • What is the risk-benefit balance of culprit vs multivessel PCI in acute MVD?
what about complete pci in stemi
What about complete PCI in STEMI?

Single vs multivessel treatment during primary angioplasty: results of the multicentre randomised HEpacoat for cuLPrit or multivessel stenting for Acute Myocardial Infarction (HELP AMI) Study.Di Mario C, Mara S, Flavio A, Imad S, Antonio M, Anna P, Emanuela P, Stefano DS,Angelo R, Stefania C, Anna F, Carmelo C, Antonio C, Monzini N, Bonardi MA.

Int J Cardiovasc Intervent. 2004;6(3-4):128-33.

slide32

53 vs 69 minutes, p<0.05

22,330€ vs 20,382€, p=NS

35% vs 17% p=NS

0 vs 4%, p=NS

Di Mario et al, Int J Cardiovasc Intervent 2004

take home messages
Take home messages
  • Current data disCOURAGE from extensive multivessel PCI based only on angiographic assessment in stable MVD
  • No definite benefits have been shown from multivessel PCI in patients with acute CAD and MVD (either STEMI or NSTEACS)
  • According to evidence available to date, PCI of non-culprit vessels can thus be recommended only is selected cases
slide34

For further slides on these topics please feel free to visit the metcardio.org website:http://www.metcardio.org/slides.html