Complete versus culprit‑only revascularization in young STEMI patients with multivessel disease

Introduction
There are still uncertainties regarding revascularization strategies in younger ST‑segment elevation myocardial infarction (STEMI) patients, largely due to limited data in this specific population.

Aim
To determine whether complete revascularization reduces major adverse cardiovascular events (MACEs) and all‑cause mortality compared to culprit‑only percutaneous coronary intervention (PCI) in cases of STEMI among patients with multivessel disease.

Material and methods
In this single‑center retrospective cohort study, we examined 431 STEMI patients treated between January 2022 and December 2023. Among these, 219 had undergone culprit‑only while 212 had received complete revascularization. Baseline demographics, angiographic and procedural variables, pharmacotherapy, laboratory, and echocardiographic data were collected. The primary endpoint was incidence of MACE, and the secondary endpoint was all‑cause mortality. Independent predictors of MACE and death were determined.

Results
The median age was 49 years (IQR 46–50), and 89.1% were male. MACE occurred in 135 (31.3%) patients, with higher incidence in the culprit‑only group (p < 0.001). Complete revascularization was associated with a 61% reduction in MACE risk (p < 0.001) and significantly lower urgent CABG requirements (p = 0.020). Elevated postoperative creatinine (p < 0.001 for MACE; p = 0.002 for mortality) and reduced postoperative left ventricular ejection fraction (p < 0.001 for MACE; p < 0.001 for mortality) were independent adverse predictors. b-blocker use (p = 0.028), antilipemic therapy (p < 0.001), and a history of hyperlipidemia (p < 0.001) were independently associated with reduced mortality.

Conclusions
In young STEMI patients with multivessel disease, complete revascularization significantly reduces MACE compared to culprit-only PCI. Renal dysfunction and impaired left ventricular ejection fraction independently predict adverse outcomes, while b-blocker and antilipemic therapy are associated with improved survival.