From the Guidelines
A staged PCI is a treatment strategy where a patient with multivessel coronary artery disease undergoes multiple PCI procedures, with the most critical lesion treated first, followed by subsequent procedures to address remaining blockages, as evidenced by the COMPLETE trial which showed a reduction in the composite endpoint of death or MI with staged PCI of the non-infarct artery performed within 45 days of STEMI 1. This approach is beneficial for reducing major adverse cardiac events (MACE) after ST-elevation myocardial infarction (STEMI), primarily by decreasing the risk of repeat revascularization and reinfarction, as supported by recent clinical performance and quality measures for coronary artery revascularization 1. Key considerations for staged PCI include:
- The timing between procedures, which can range from days to weeks, depending on the patient's condition and clinical urgency
- The potential benefits of reducing procedural time, radiation exposure, and contrast-induced nephropathy
- The importance of reassessing the patient's condition between procedures to modify the treatment plan as needed
- The suitability of staged PCI for patients with complex coronary anatomy, compromised heart function, or significant comorbidities, such as kidney disease or advanced age, as these factors may influence the decision to adopt a staged approach over a single, prolonged procedure 1.
From the Research
Definition of Staged PCI
- A staged percutaneous coronary intervention (PCI) refers to a procedure where multiple coronary interventions are performed in separate sessions, rather than in a single session 2, 3.
- This approach is often used in patients with complex coronary artery disease, such as those with multivessel disease or those who require both coronary revascularization and valve surgery 3.
Indications for Staged PCI
- Staged PCI may be indicated in patients with stable coronary artery disease or non-ST-elevation acute coronary syndrome who require elective multivessel PCI 2.
- It may also be used in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease, where the non-culprit lesions are treated in a staged procedure after primary PCI 4.
Timing of Staged PCI
- The optimal timing of staged PCI is still controversial, but studies suggest that it should be performed within 1-2 weeks after primary PCI in STEMI patients with multivessel disease 4.
- In patients with stable coronary artery disease, the timing of staged PCI may depend on individual patient factors, such as clinical and angiographic characteristics 2.
Benefits and Risks of Staged PCI
- Staged PCI may be associated with a lower risk of major adverse cardiovascular events (MACE) compared to single-session PCI, particularly in patients with complex coronary artery disease 2, 4.
- However, staged PCI may also be associated with a higher risk of bleeding and transfusion requirements, particularly in patients who undergo valve surgery after PCI 3.