Twelve-Month Clinical Outcomes of Multivessel Versus Culprit-Only Percutaneous Coronary Intervention in Hemodynamically Stable Patients with ST-Segment Elevation Myocardial Infarction and Multivessel Coronary Artery Disease: A Retrospective Comparative Cohort Study

Abstract

Objective: This study compared 12-month clinical outcomes following multivessel primary percutaneous coronary intervention (PCI) and culprit-only PCI among hemodynamically stable patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease (CAD) treated at a tertiary care cardiac center in Pakistan. Methodology: A retrospective cohort study included 400 consecutive patients with STEMI and multivessel CAD undergoing primary PCI at Lady Reading Hospital, Peshawar. Patients were equally divided into multivessel PCI (n=200) and culprit-only PCI (n=200) groups. The primary outcome was 12-month MACE, comprising cardiovascular death, recurrent myocardial infarction, or unplanned revascularization. Secondary outcomes included all-cause mortality, heart failure hospitalization, stroke, acute kidney injury, and major bleeding Results: A total of 400 patients were analyzed, with comparable baseline characteristics between groups. At 12 months, multivessel PCI significantly reduced MACE (13.5% vs. 22.5%; RR 0.60, 95% CI 0.39–0.93; p=0.019) and unplanned revascularization (6.0% vs. 13.5%; p=0.011) compared with culprit-only PCI. After adjustment, multivessel PCI remained independently associated with lower MACE (adjusted OR 0.487; p=0.011) and repeat revascularization (adjusted OR 0.383; p=0.010). Although acute kidney injury was initially more frequent with multivessel PCI (12.5% vs. 5.5%; p=0.014), this association was not significant after adjustment. No significant differences were observed in mortality, recurrent myocardial infarction, stroke, heart failure hospitalization, or major bleeding Conclusion: Among hemodynamically stable patients with STEMI and multivessel coronary artery disease, multivessel PCI was associated with fewer 12-month major adverse cardiovascular events and repeat coronary revascularizations than culprit-only PCI.