Use of multivessel (MV) PCI among STEMI patients increased through early 2018, but was used in a minority of patients and with wide variations across the U.S., according to a study published Nov. 4 in JAMA Cardiology. The study is part of ACC's Research to Practice (R2P) initiative, which identifies impactful cardiovascular research and analyzes its implications for contemporary clinical practice using ACC's NCDR clinical registries.

Eric A. Secemsky, MD, FACC, et al., used data from ACC's CathPCI Registry to examine temporal trends and institutional variation in use of MV PCI among patients with STEMI and MV disease. The researchers looked at all admissions between July 2009 and March 2018 in which patients received primary PCI for STEMI within 12 or fewer hours of presentation or PCI within 24 or fewer hours of thrombolysis and also had MV disease.

Among all STEMI admissions, 359,879 (35.2%) were included in the study. Of these, 138,380 (38.5%) received MV PCI within 45 days. Among patients receiving MV PCI, 42,629 (30.8%) were performed during the index procedure, 43,696 (31.6%) during the index hospitalization and 52,055 (37.6%) within 45 days. Complete revascularization was performed in 105,389 (76.2%) of those who underwent MV PCI. Use of MV PCI declined by 10% from the third quarter of 2009, when the rate was 42.7%, to the second quarter of 2013, with the rate was 32.7%, followed by an increase to 44% in the fourth quarter of 2017. The authors found substantial variation in the in MV PCI across institutions, with a median use of 37.9%.

MV PCI use increased during the study period, but it was used in a minority of patients and with wide variations across institutions, the researchers explain. Moving forward, "continued adoption of new trial results into guidelines and practice may further promote the growth of MV PCI," they conclude.

In an accompanying editorial commentary, John A. Bittl, MD, FACC, notes that the difference of 11 percentage points between the periods with lowest and highest uptake of MV PCI "probably reflects the belief throughout all periods that culprit-only PCI is the default strategy, with preemptive PCI on nonculprit vessels being reserved for special circumstances." He adds that Secemsky et al., "should be commended for showing that culprit-only PCI is the preferred approach in practice and routine multivessel PCI is unpropitious."

Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Stable Ischemic Heart Disease, Vascular Medicine, Interventions and Vascular Medicine, Chronic Angina

Keywords: ST Elevation Myocardial Infarction, Percutaneous Coronary Intervention, Registries, National Cardiovascular Data Registries, Cardiology, Hospitalization, Thrombolytic Therapy, CathPCI Registry

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