Timing of Complete Revascularization with Multivessel PCI for Myocardial Infarction

The MULTISTARS AMI trial randomized 840 hemodynamically stable patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease across 37 European sites to either immediate complete PCI at index procedure or staged PCI within 19–45 days. Primary composite endpoint (death, nonfatal MI, stroke, ischemia-driven revascularization, or heart failure hospitalization at 1 year):

Immediate group: 8.5%

Staged group: 16.3% (Risk ratio = 0.52; P < 0.001 for superiority) Significant reductions in nonfatal MI (2.0% vs. 5.3%) and unplanned ischemia-driven revascularization (4.1% vs. 9.3%) drove the benefit. Stroke, heart failure hospitalization, and mortality showed no difference. Quality-of-life scores (EQ-5D-5L) were similar, while serious adverse events were lower in the immediate group (104 vs. 145). Subgroup analyses confirmed consistent benefit across age, sex, infarct location, diabetes status, access site, and lesion complexity. Immediate PCI had longer procedure time (∼105 min vs. 52+ min), higher stent count and contrast volume, but yielded earlier protection against procedural MI and urgent revascularization. Trial supports safe, effective use of immediate multivessel PCI in STEMI without cardiogenic shock or high-complexity anatomy—redefining procedural timing.

The MULTISTARS AMI trial randomized 840 hemodynamically stable patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease across 37 European sites to either immediate complete PCI at index procedure or staged PCI within 19–45 days. Primary composite endpoint (death, nonfatal MI, stroke, ischemia-driven revascularization, or heart failure hospitalization at 1 year):

Immediate group: 8.5%

Staged group: 16.3% (Risk ratio = 0.52; P < 0.001 for superiority) Significant reductions in nonfatal MI (2.0% vs. 5.3%) and unplanned ischemia-driven revascularization (4.1% vs. 9.3%) drove the benefit. Stroke, heart failure hospitalization, and mortality showed no difference. Quality-of-life scores (EQ-5D-5L) were similar, while serious adverse events were lower in the immediate group (104 vs. 145). Subgroup analyses confirmed consistent benefit across age, sex, infarct location, diabetes status, access site, and lesion complexity. Immediate PCI had longer procedure time (∼105 min vs. 52+ min), higher stent count and contrast volume, but yielded earlier protection against procedural MI and urgent revascularization. Trial supports safe, effective use of immediate multivessel PCI in STEMI without cardiogenic shock or high-complexity anatomy—redefining procedural timing.