Rotterdam, Netherlands; 10 Thorax Center, Erasmus MC, Rotterdam, Netherlands BACKGROUND Among patients with re-infarction (ReMI) that occurred after ST-segment elevation myocardial infarction (STEMI), the impact of ReMI etiology on the long-term prognosis is not clearly established. The study aims to compare the influence of stent thrombosis (ST) and non-stent-related recurrent myocardial infarction (NS-ReMI) on prognosis after primary percutaneous coronary inter- vention (PCI). METHODS This is a single-centre observational study evaluating the impact of ST and NS-ReMI in patients with prior STEMI and already treated with primary PCI. Patients included in the present analysis had at least 1-year follow-up after ReMI and clinical events were compared between ST-related ReMI (ST-ReMI) and NS-ReMI groups. RESULTS A total of 4226 STEMI patients treated with primary PCI with a median follow up of 1131 days (IQR 777 – 1753) were evaluated. ReMI occurred in 217 (5.2%) patients and in 190 a minimum follow-up of one year after ReMI was available (median follow-up after ReMI 1707 days (IQR 1001 – 2591). ST-ReMI was identified in 109 (57.4%) patients. ST-ReMI occurred earlier after index PCI than NS-ReMI (time to ReMI: 365.9 Æ 530.8 vs. 960.1 Æ 986.3, p ¼ 0.001). In ST-ReMI patients a higher mortality was observed at one year (11.9% vs. 3.7%, p ¼ 0.044). The second ReMI (8.3% vs. 7.4%, p ¼ 0.830) occurred with similar frequency in both groups. Landmark survival analysis per- formed at 30 days after ReMI revealed higher rate of death at 30 days post-reinfarction in ST-ReMI group (7.0% vs. 3.0%, p ¼ 0.029) fol- lowed by similar rate of death between 30 days and 1 year after ReMI (5.0% vs 2.5%, p ¼ 0.391). At multivariate Cox regression analysis adjusted for confounders with p < 0.1, ST as an etiology of ReMI remained an independent predictor of mortality (HR 2.59, 95% CI: 1.09-6.17, p ¼ 0.030). CONCLUSION In STEMI population prognosis after ReMI differs based on its etiology. ReMI caused by ST is associated with higher mortality as compared to NS-ReMI at one-year follow-up, which is mainly related to the events occurring within one month post ReMI. CATEGORIES CORONARY: Acute Myocardial Infarction TCT-636 Multivessel Disease in STEMI patients: A Meta-analysis comparing the timing (index vs. staged) of achieving complete revascularization Alexandre Hideo-Kajita, 1 Hector Garcia-Garcia, 2 Kayode Kuku, 1 Solomon Beyene, 1 Viana Azizi, 1 Yael Meirovich, 3 Gebremedhin Melaku, 4 Ahn Bui, 1 Aaphtaab Dheendsa, 1 Echo Brathwaite, 1 Sameer Desale, 1 Michael Lipinski, 1 Ron Waksman 1 1 Medstar Washington Hospital Center, Washington, District of Columbia, United States; 2 Medstar Washington Medical Center, Bethesda, Maryland, United States; Health Research Institute, Hyattsville, Maryland, United States; 3 MCRN, Washington, District of Columbia, United States; 4 Medstar Health Research Institute, Washington, Maryland, United States BACKGROUND Current guidelines for percutaneous revascularization in patients with ST elevation myocardial infarction (STEMI) and multivessel disease (MVD) advise restricting intervention to the culprit vessel at the index procedure. However, recent data, suggests that complete revascularization (CR) is associated with improvement of outcomes in MVD patients. Thus, complete revascularization strategy can be performed at the index procedure (e.g. index complete revascularization – ICR) or staged in a second procedure within a specific time (e.g. staged complete revascularization – SCR). The aim of this meta-analysis is to determine if there is any significant difference between ICR and SCR. METHODS A literature search of PubMed was performed to identify studies published from January 2004 to May 2017. Pooled estimates of outcomes, presented as odds ratios (OR) [95% confidence intervals], were generated with random-effects model. The analysis compared the population of 9 studies (8 randomized controlled trials and 1 propensity-score matching study, total of 3.401 patients), of whom 1.574 patients were treated with CR. A total of 646 patients underwent ICR and 928 patients in the SCR group. RESULTS The major adverse cardiovascular events (MACE) incidence rate was 10.8% (OR 0.33, 95% CI: 0.24-0.45, p<0.00001) in the ICR group compared to 17.2% (OR 0.58, 95% CI: 0.40-0.84, p<0.004) in the SCR group (Figure 1); all-cause mortality in the ICR group was 3.5% (OR 0.69, 95% CI: 0.41-1.19, p¼0.18) and 4.5% (OR 0.66, 95% CI: 0.36-1.22, p¼0.19)in the SCR group ; the incidence of All-MI was 2.6% (OR 0.39, 95% CI: 0.22-0.68, p¼0.0010) in the ICR group and 5.9.% in the SCR group (OR 0.95, 95% CI: 0.56-1.61, p¼0.86); the incidence of repeat revascularization was 7.5% (OR 0.29, 95% CI: 0.21-0.41, p<0.00001) in the ICR group compared to 9.0% (OR 0.45, 95% CI: 0.29-0.72, p¼0.0007) in the SCR group. CONCLUSION Compared to staged PCI, achieving complete revascu- larization at index procedure demonstrated reductions in MACE, all- MI and repeat revascularization. CATEGORIES CORONARY: Acute Myocardial Infarction TCT-637 Accuracy of Pre-Hospital EKG for Cath Lab Activation Cheng Chen, 1 Henry Chu, 2 Sam Torbati, 3 David Lange, 2 Timothy Henry 3 1 Cedars-Sinai Medical Center, Los Angeles, United States; 2 Cedars Sinai Medical Center, Los Angeles, California, United States; 3 Cedars-Sinai Medical Center, Los Angeles, California, United States BACKGROUND STEMI activation based on the pre-hospital ECGs (PHECGs) can be challenging to incorporate accurate EKG interpreta- tion in appropriate clinical scenarios. Previously at Cedars-Sinai Medical Center (CSMC) although the cath lab was already activated, a cardiology fellow would assess the patient in the emergency depart- ment (ED) and make a decision to proceed with emergent catheteri- zation. This study aims to determine the accuracy of the fellow based process. METHODS This is a single-centered, retrospective cohort study of 100 consecutive patients who were evaluated in the ED at CSMC after PHECG prompted STEMI activation. Angiographic and cardiac biomarker data were reviewed. The EKGs and clinical history were reviewed by a CCU Attending and ED Physician in a blinded fashion. Patients were considered to have true STEMI if they have ischemic symptoms, ST elevation on EKG and typical rise and fall of troponin. A missed STEMI is defined by patient having true STEMI but did not undergo emergent catheterization. RESULTS The average age of the group was 68 years old and 41% are female. Out of the 100 patients, 26 were true STEMI; 21 patient went to catheterization lab emergently; 2 patients did not go due to neurologic (1 unclear, 1 stroke); true STEMI was “missed” in 3/26 (11.5%). 75/100 STEMI activations were canceled by cardiology fellows in the ED. 72 were appropriate cancelations and 3 were true STEMI. The top reasons for false activations include poor quality ECG/artifact (27, 36%), bundle branch block (12, 16%), arrhythmia (9, 12%) and early repo- larization (9, 12%). Kappa coefficient on decision to cancel STEMI activation for cardiology and emergency medicine attending was 0.80 (95% CI 0.67-0.93) and 0.71 (95% CI 0.55-0.87) respectively. Kappa coefficient of reasons for cancelation was also calculated for the JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 70, NO. 18, SUPPL B, 2017 B281