Immediate multivessel PCI was non-inferior to staged multivessel PCI for reducing death and ischemic events in patients with STEMI and multivessel coronary artery disease, according to results from the MULTISTARS AMI trial presented at ESC Congress 2023.

Researchers randomized 840 patients with acute STEMI and multivessel coronary artery disease from 37 sites in Europe to either immediate PCI or staged PCI of non-culprit lesions within 19-45 days. The average age of participants as 65 years and approximately 21% were women. The primary endpoint was a composite of all-cause death, non-fatal myocardial infarction, stroke, unplanned ischemia-driven revascularization, or hospitalization for heart failure within one year.

The primary endpoint occurred in 35 patients (8.5%) in the immediate PCI group and in 68 patients (16.3%) in the staged PCI group (p<0.001 for non-inferiority; p<0.001 for superiority). Additionally, non-fatal myocardial infarction occurred in eight patients (2.0%) in the immediate PCI group and in 22 patients (5.3%) in the staged group, while unplanned ischemia-driven revascularization was performed in 17 patients (4.1%) in the immediate PCI group compared with 39 patients (9.3%) in the staged PCI group. No differences were observed across both groups in terms of all-cause death, stroke and hospitalization for heart failure.

"MULTISTARS AMI addresses the clinically important question of the optimal timing for a complete revascularization of patients with STEMI and multivessel coronary artery disease," said Barbara Stähli, MD, of the University Hospital Zurich, Switzerland. "The trial has implications for clinical practice, as it demonstrated that immediate PCI of non-culprit lesions is as effective and safe as a staged procedure. Results were generally consistent across prespecified key subgroups, particularly among women and men, young and older patients, and patients with or without diabetes."

Clinical Topics: Acute Coronary Syndromes, Invasive Cardiovascular Angiography and Intervention, Interventions and ACS

Keywords: ESC Congress, ESC23, ACC International, Acute Coronary Syndrome, Percutaneous Coronary Intervention

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