Objective: Approximately 50% of ST-segment elevation myocardial infarction (STEMI) patients have multivessel coronary artery disease (MVD). The management strategy for these patients remains controversial. This study aimed to develop predictive models and nomogram of outcomes in STEMI patients with MVD for better identification and classification. Methods: The least absolute shrinkage and selection operator (LASSO) method was used to select the features most significantly associated with the outcomes. A Cox regression model was built using the selected variables. One nomogram was computed from each model, and individual risk scores were obtained by applying the nomograms to the cohort. After regrouping patients based on nomogram risk scores into low- and high-risk groups, we used the Kaplan–Meier method to perform survival analysis. Results: The C-index of the major adverse cardiovascular event (MACE)-free survival model was 0· 68 (95% CI 0· 62– 0· 74) and 0· 65 [0· 62– 0· 68]) at internal validation, and that of the overall survival model was 0· 75 (95% CI 0· 66– 0· 84) and (0· 73 [0· 65– 0· 81]). The predictions of both models correlated with the observed outcomes. Low-risk patients had significantly lower probabilities of 1-year or 3-year MACEs (4% versus 11%, P = 0.003; 7% versus 15%, P =0.01, respectively) and 1-year or 3-year all-cause death (1% versus 3%, P =0.048; 2% versus 7%, respectively, P =0.001) than high-risk patients. Conclusion: Our nomograms can be used to predict STEMI and MVD outcomes in a simple and practical way for patients who undergo primary PCI for culprit vessels and staged PCI for non-culprit vessels. Keywords: ST-segment elevation myocardial infarction, multivessel coronary artery disease, percutaneous coronary intervention, major adverse cardiovascular events, all-cause death 

Nomogram to Predict Outcomes After Staged Revascularization in ST-Segment Elevation Myocardial Infarction and Multivessel Coronary Artery Disease

INTRODUCTION Complete revascularization of ST-elevation myocardial infarction (STEMI) patients with multivessel disease (MVD) has recently shown to reduce risk of adverse cardiovascular events, including cardiovascular death. Optimal timing of revascularization of nonculprit lesions remains controversial. We aimed to measure cardiac outcomes related to duration between primary percutaneous coronary intervention (pPCI) of the culprit lesion and staged PCI (sPCI) of nonculprit lesions. METHODS From a prospectively collected consecutive registry of 3,002 patients treated for STEMI by pPCI, 1,555 patients with MVD requiring sPCI were identified. Patients were placed into quartiles of duration to sPCI: 0-7 days (Q1), 7-22 days (Q2), 22-42 days (Q3), >42 days (Q4), excluding those who had complete revascularization at the index event. Major adverse cardiac events (MACEs) included all-cause mortality, myocardial infarction, target vessel revascularization, and coronary artery bypass surgery. Cox regression and propensity score matching were performed correcting for confounding factors. RESULTS The average age at presentation was 65.7 ± 11.5 years. 333 were female (21.4%). Mean time between pPCI and sPCI was 28.3 days (±24.8). Rates of MACE were Q1 - 16.5%, Q2 - 21.2%, Q3 - 25.8%, and Q4 - 30.1% (log-rank <0.001). Following regression analysis, sPCI remained an independent risk factor for MACE (hazard ratio [HR] = 1.226 [95% confidence interval {CI}: 1.129-1.331, p < 0.001]). There was no association between the time interval up to sPCI with all-cause death (HR = 1.022 [95% CI: 0.925-1.129, p = 0.671]). CONCLUSIONS Patients with MVD are at increased risk of experiencing MACE after revascularization of nonculprit vessels with increasing time delay between pPCI and sPCI.

Timing of Nonculprit Percutaneous Coronary Intervention after ST-Elevation Myocardial Infarction.

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Timing of Nonculprit Percutaneous Coronary Intervention after ST-Elevation Myocardial Infarction.