Single or Multivessel Percutaneous Coronary Intervention in ST-Elevation Myocardial Infarction Patients Elisabetta Varani, * MD, Marco Balducelli, MD, Matteo Aquilina, MD, Giuseppe Vecchi, MD, Mohamed Naseem Hussien, MD, Valeria Frassineti, MSc, and Aleardo Maresta, MD, FACC Objectives: To evaluate clinical results of percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) in patients with multivessel disease (MVD), in relation to single or multivessel (MV)-PCI and to patients with single vessel disease (SVD). Methods: Patients treated with PCI in the setting of <24 hr STEMI in the years 2004–2007 were considered. Results: Seven hundred forty-five primary PCI, 346 (46%) in patients with SVD and 399 (54%) in patients with MVD were performed. Among MVD patients, 156 (39%) had infarct related artery (IRA)-only treatment and 243 had MV-PCI: 147 (37%) in a single session, 48 (12%) within 24 hr, and 48 (12%) predischarge. Revas- cularization was complete in 46% of MVD patients. At a median follow-up of 597 days, mortality was 6.3% in SVD and 12% in MVD (P 5 0.007), new revascularization 2.9% and 9%, respectively (P < 0.001). Thirty-day mortality was 2.4% in SVD and 6.7% in MVD (P 5 0.006). After exclusion of patients with cardiogenic shock or pulmonary oedema, more frequent in the MV-PCI in single session group (P 5 0.006), 30-day mortality was SVD 1.3%, IRA-only 6.3%, MV-PCI 2.8% (P 5 0.023), without differences if in a single (3.3%) or in staged session (2.2%). By multivariate analysis, female sex, anterior STEMI, cardio- genic shock, MVD, and procedural failure were independent predictors of 30-day mortal- ity. Conclusions: STEMI patients with MVD have a worse prognosis than those with SVD. MV-PCI in patients without hemodynamic compromise yields good short-term results, even if performed very early, with a 30-day mortality in between that of SVD patients and that of MVD patients with IRA-only treatment. ' 2008 Wiley-Liss, Inc. Key words: primary angioplasty; myocardial infarction; multivessel disease; prognosis INTRODUCTION Primary percutaneous coronary intervention (PCI) is considered to be the treatment of choice for STEMI patients [1]. Patients (40–65%) have multivessel (MV) coronary artery disease, a negative prognostic predictor of long-term outcome [2]. This notwithstanding, treat- ment of nonculprit lesions is not recommended by present guidelines unless hemodynamic compromise or residual ischemia are present [1]. The actual risk/bene- fit ratio of a MV percutaneous intervention in STEMI patients during the first hospital stay is unclear espe- cially if one considers the technological and pharmaco- logical adjuncts presently available. Literature reports give conflicting results [3–10] and sufficiently powered randomized clinical trials are lacking [11,12]. Purpose of this study was to examine the prognostic impact of multivessel disease (MVD) and of the strat- egy of revascularization [infarct related artery (IRA)- only or MV-PCI] on clinical outcomes in a cohort of patients with STEMI treated with primary PCI. MATERIALS AND METHODS Study Population All STEMI patients with symptoms duration <24 hr treated with primary PCI at our institution from January 2004 until December 2007, with the only exclusion of patients undergoing PCI for acute Conflict of interest: Nothing to report. Department of Cardiology, S. Maria delle Croci Hospital, Rav- enna, Italy *Correspondence to: Elisabetta Varani, MD, Department of Cardiol- ogy, S. Maria delle Croci Hospital, Viale Randi, 5, 48100 Ravenna, Italy. E-mail: ra.hocardioemo@ausl.ra.it Received 23 May 2008; Revision accepted 1 July 2008 DOI 10.1002/ccd.21722 Published online 16 September 2008 in Wiley InterScience (www. interscience.wiley.com). ' 2008 Wiley-Liss, Inc. Catheterization and Cardiovascular Interventions 72:927–933 (2008)