This study compares two treatment strategies in patients with ST-elevation myocardial infarction (STEMI) and multivessel coronary artery disease (MVD) undergoing a pharmaco-invasive approach after successful fibrinolysis. The study evaluates whether one-time complete revascularization, in which the culprit and significant non-culprit lesions are treated during the same percutaneous coronary intervention (PCI) session, is better than a staged strategy, in which non-culprit lesions are treated in a separate percutaneous coronary intervention (PCI) procedure within 1 month. The hypothesis is that one-time complete revascularization may reduce hospitalization time, cost, and recurrent ischemic symptoms without increasing short-term complications. Participants are adults with acute ST-elevation myocardial infarction (STEMI) and multivessel coronary artery disease (MVD) who had successful fibrinolysis followed by coronary angiography and percutaneous coronary intervention (PCI). Outcomes include total hospitalization time, total expenses, contrast-induced nephropathy (CIN) within 72 hours, and major adverse cardiovascular events (MACE) during 3 months of follow-up.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
112
Revascularization strategy in which the culprit coronary artery and all significant non-culprit lesions are treated during the index percutaneous coronary intervention session after successful fibrinolysis.
Revascularization strategy in which only the culprit coronary artery is treated during the index percutaneous coronary intervention session after successful fibrinolysis, with treatment of significant non-culprit lesions deferred to a separate staged percutaneous coronary intervention within 1 month after discharge.
Helwan University Hospital
Cairo, Cairo Governorate, Egypt
Total hospitalization time
Total duration of hospitalization in days. For participants assigned to staged revascularization, the duration of the staged admission was added to the index admission to calculate the total hospitalization time.
Time frame: up to 1 month post operatively
Total expenses
Total treatment-related expenses in Egyptian pounds for the index admission and, when applicable, the staged admission.
Time frame: up to 1 month post operatively
Contrast-induced nephropathy
Increase in serum creatinine by at least 0.5 milligrams per deciliter or at least 25 percent from baseline within 72 hours after percutaneous coronary intervention.
Time frame: Within 72 hours after percutaneous coronary intervention
Angina-related hospitalization
Hospital admission due to recurrent anginal symptoms during follow-up.
Time frame: Within 3 months after index percutaneous coronary intervention
Left ventricular ejection fraction
Left ventricular systolic function assessed by transthoracic echocardiography using the modified Simpson method.
Time frame: Baseline and 3 months after index percutaneous coronary intervention
Wall motion score index
Regional left ventricular wall motion score index assessed by transthoracic echocardiography.
Time frame: Baseline and 3 months after index percutaneous coronary intervention
Serum creatinine
Serum creatinine concentration measured to assess renal function.
Time frame: Baseline, 72 hours after percutaneous coronary intervention, and 3 months
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