DefinePK

Research Objective

To compare the clinical outcomes of complete revascularization and culprit-only revascularization in patients with multivessel coronary artery disease (CAD) who presented with ST-segment elevation myocardial infarction (STEMI).

Methodology

A prospective, randomized controlled trial involving 400 patients with multivessel CAD presenting with STEMI. Patients were randomized into two groups: complete revascularization (n=200) or culprit-only revascularization (n=200). Primary outcomes included cardiovascular death, reinfarction, and the need for repeat revascularization over a six-month follow-up. Statistical analysis used chi-square tests and Kaplan-Meier survival analysis.

Methodology Flowchart

                        graph TD;
    A["Enroll 400 STEMI patients with multivessel CAD"] --> B["Random Assignment"];
    B --> C["Complete Revascularization Group n=200"];
    B --> D["Culprit-only Revascularization Group n=200"];
    C --> E["Assess Primary Outcomes 6-month follow-up"];
    D --> E;
    E --> F["Statistical Analysis Chi-square, Kaplan-Meier"];
    F --> G["Compare Outcomes"];                    

Discussion

The study supports complete revascularization as a superior strategy for improving clinical outcomes in STEMI patients with multivessel CAD, aligning with global research. It highlights the need for localized data in Pakistan, where such comprehensive trials were previously lacking. Limitations include single-center participation and a six-month follow-up period.

Key Findings

Complete revascularization significantly reduced major adverse cardiovascular events compared to culprit-only revascularization. Cardiovascular death was lower (4% vs 9%, p=0.02), reinfarction rates were lower (5% vs 11%, p=0.01), and the need for repeat revascularization was lower (7% vs 15%, p=0.004) in the complete revascularization group.

Conclusion

Complete revascularization significantly improves clinical outcomes in patients with multivessel CAD presenting with STEMI, reducing cardiovascular death, reinfarction, and repeat revascularization. It is recommended as a preferred treatment strategy for better long-term outcomes.

Fact Check

- 400 patients were enrolled and randomized into two groups of 200 each.
- Cardiovascular death rates were 4% in the complete revascularization group and 9% in the culprit-only group.
- Reinfarction rates were 5% in the complete revascularization group and 11% in the culprit-only group.

Mind Map