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Background <p>Renal dysfunction might affect outcomes in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease (MVD) undergoing percutaneous coronary intervention (PCI).</p> Methods <p>In MULTISTARS AMI, patients with STEMI and MVD were randomized to immediate or staged PCI of non-culprit lesions. In this pre-specified analysis, patients were stratified according to the presence of renal dysfunction at baseline, defined at an estimated glomerular filtration rate (eGFR) of 60&#xa0;ml/min/1.73 m<sup>2</sup>. Patients with an eGFR &lt; 30&#xa0;ml/min/1.73 m<sup>2</sup> were excluded from the trial. The primary endpoint was a composite of death, non-fatal myocardial infarction, stroke, unplanned revascularization, or hospitalization for heart failure at 1&#xa0;year.</p> Results <p>In MULTISTARS AMI, 108 (13%) of 832 patients had renal dysfunction. The primary endpoint occurred more frequently in patients with renal dysfunction (19.4% vs. 11.2%, unadjusted HR 1.82, 95% CI 1.13–2.94), primarily driven by higher rates of death. Among patients with renal dysfunction, the rates of the primary end point were 14.5% and 24.5% in the immediate and staged PCI groups (unadjusted HR 0.55, 95% CI 0.23–1.33). There was no interaction between renal dysfunction and the randomized treatment assignment with respect to the primary end point (adjusted HR 1.30, 95% CI 0.8–2.20, p<sub>int</sub> 0.82). The occurrence of acute renal insufficiency was statistically similar in patients with renal dysfunction who underwent immediate and staged PCI (10.9% vs. 18.9%, unadjusted HR 0.61, 95% CI 0.22–1.72, p<sub>int</sub> 0.09). Renal dysfunction at baseline emerged as a strong risk factor for the development of acute renal insufficiency (adjusted HR 5.0, 95% CI 2.30–10.70, <i>p</i> &lt; 0.01).</p> Conclusions <p>Outcomes with immediate compared to staged multivessel PCI did not appear significantly altered by the presence of renal dysfunction&#xa0;at baseline. (Supported by Boston Scientific; MULTISTARS AMI ClinicalTrials.gov number, NCT03135275).</p> Graphical Abstract <p></p>

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Impact of renal dysfunction on immediate versus staged revascularization of non-culprit lesions in patients with ST segment elevation myocardial infarction: a pre-specified subgroup analysis of the randomized MULTISTARS AMI trial

  • 期刊论文

  • 发表日期：

    2026年3月9日

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  • Miklos Rohla,
  • Kurt Huber,
  • Ferdinando Varbella,
  • Axel Linke,
  • Bettina Schwarz,
  • Stephan B. Felix,
  • Moritz Seiffert,
  • Rahel Kesterke,
  • Peter Nordbeck,
  • Bernhard Witzenbichler,
  • Irene M. Lang,
  • Mirjam Kessler,
  • Christian Valina,
  • Alban Dibra,
  • Philipp Jakob,
  • Marco Moccetti,
  • Matteo Vercellino,
  • Luise Gaede,
  • Lorenz Bott-Flügel,
  • Julia Stehli,
  • Alessandro Candreva,
  • Francesco Paneni,
  • Christian Templin,
  • Matthias Schindler,
  • Manfred Wischnewsky,
  • Greca Zanda,
  • Giorgio Quadri,
  • Norman Mangner,
  • Aurel Toma,
  • Giulia Magnani,
  • Peter Clemmensen,
  • Thomas F. Lüscher,
  • Thomas Münzel,
  • P. Christian Schulze,
  • Karl-Ludwig Laugitz,
  • Wolfgang Rottbauer,
  • Franz-Josef Neumann,
  • Steffen Schneider,
  • Thomas Riemer,
  • Franz Weidinger,
  • Stephan Achenbach,
  • Gert Richardt,
  • Adnan Kastrati,
  • Ian Ford,
  • Frank Ruschitzka,
  • Barbara E. Stähli

摘要

Background

Renal dysfunction might affect outcomes in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease (MVD) undergoing percutaneous coronary intervention (PCI).

Methods

In MULTISTARS AMI, patients with STEMI and MVD were randomized to immediate or staged PCI of non-culprit lesions. In this pre-specified analysis, patients were stratified according to the presence of renal dysfunction at baseline, defined at an estimated glomerular filtration rate (eGFR) of 60 ml/min/1.73 m2. Patients with an eGFR < 30 ml/min/1.73 m2 were excluded from the trial. The primary endpoint was a composite of death, non-fatal myocardial infarction, stroke, unplanned revascularization, or hospitalization for heart failure at 1 year.

Results

In MULTISTARS AMI, 108 (13%) of 832 patients had renal dysfunction. The primary endpoint occurred more frequently in patients with renal dysfunction (19.4% vs. 11.2%, unadjusted HR 1.82, 95% CI 1.13–2.94), primarily driven by higher rates of death. Among patients with renal dysfunction, the rates of the primary end point were 14.5% and 24.5% in the immediate and staged PCI groups (unadjusted HR 0.55, 95% CI 0.23–1.33). There was no interaction between renal dysfunction and the randomized treatment assignment with respect to the primary end point (adjusted HR 1.30, 95% CI 0.8–2.20, pint 0.82). The occurrence of acute renal insufficiency was statistically similar in patients with renal dysfunction who underwent immediate and staged PCI (10.9% vs. 18.9%, unadjusted HR 0.61, 95% CI 0.22–1.72, pint 0.09). Renal dysfunction at baseline emerged as a strong risk factor for the development of acute renal insufficiency (adjusted HR 5.0, 95% CI 2.30–10.70, p < 0.01).

Conclusions

Outcomes with immediate compared to staged multivessel PCI did not appear significantly altered by the presence of renal dysfunction at baseline. (Supported by Boston Scientific; MULTISTARS AMI ClinicalTrials.gov number, NCT03135275).

Graphical Abstract