Killip class at presentation and immediate versus staged multivessel PCI in patients with STEMI.

DOI
Publisher DOI
PubMed ID
42362625
Abstract
Patients with ST-segment elevation myocardial infarction (STEMI) and higher Killip class are at an increased risk of death. We sought to assess outcomes of an immediate or staged multivessel percutaneous coronary intervention (PCI) in patients with higher Killip class presenting with STEMI and multivessel coronary artery disease (MVD). We conducted a subgroup analysis of the MULTISTARS AMI trial with stratification of patients according to Killip classes. Outcomes of patients with Killip class I and Killip class ≥ II were compared. The primary end point was a composite of all-cause death, non-fatal myocardial infarction, stroke, unplanned ischemia-driven revascularization, or hospitalization for heart failure at 1 year. The primary end point occurred in 15 (17.9%) patients with Killip class ≥ II and 78 (11.4%) patients with Killip class I (HR, 1.57 [95%CI, 0.92-2.70], p-value = 0.11). Comparing an immediate with a staged multivessel PCI strategy, the immediate strategy reduced the primary endpoint in patients with Killip class I (6.8% vs. 15.8%; HR, 0.40 [95%CI, 0.25-0.65], p-value < 0.01), whereas the difference was not significant in patients with Killip class ≥ II (20.0% vs. 15.4%; HR, 1.37 [95%CI, 0.50-3.78], p-value = 0.55). There was a significant treatment-by-subgroup interaction for the primary endpoint (P interaction = 0.029), with immediate multivessel PCI not showing an advantage in Killip class ≥ II patients. Conclusively, in the MULTISTARS AMI trial, the benefit of immediate multivessel revascularization strategy observed in patients with Killip class I appeared attenuated in those presenting with Killip class ≥ II, suggesting a potential difference in treatment effect that warrants further investigation. (Supported by Boston Scientific; MULTISTARS AMI, NCT03135275).
Date Issued
2026
Publication Type
Article
Subject(s)
Subjects
Acute coronary syndrome
•
Heart failure
•
Immediate complete revascularization
•
Killip class
•
Multivessel disease
•
Percutaneous coronary intervention
Language(s)
en
Author(s)
Jakob, Philipp
Varbella, Ferdinando
Linke, Axel
Felix, Stephan B
Seiffert, Moritz
Kesterke, Rahel
Nordbeck, Peter
Witzenbichler, Bernhard
Lang, Irene M
Kessler, Mirjam
Valina, Christian
Dibra, Alban
Moccetti, Marco
Vercellino, Matteo
Gaede, Luise
Bott-Flügel, Lorenz
Stehli, Julia
Würdinger, Michael
Paneni, Francesco
Templin, Christian
Wischnewsky, Manfred
Zanda, Greca
Quadri, Giorgio
Mangner, Norman
Toma, Aurel
Clemmensen, Peter
Münzel, Thomas
Schulze, P Christian
Laugwitz, Karl-Ludwig
Rottbauer, Wolfgang
Huber, Kurt
Neumann, Franz-Josef
Schneider, Steffen
Riemer, Thomas
Weidinger, Franz
Achenbach, Stephan
Richardt, Gert
Kastrati, Adnan
Ford, Ian
Ruschitzka, Frank
Additional Credits
Journal
Scientific Reports
Publisher
Nature Research
ISSN
2045-2322
Access(Rights)
open.access
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