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.
Miklos Rohla, Kurt Huber, Ferdinando Varbella et al.
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In 30 seconds
This pre-specified subgroup analysis of the randomized, multicentre MULTISTARS AMI trial examined whether baseline renal dysfunction affected outcomes with immediate versus staged PCI of non-culprit lesions in patients with STEMI and multivessel coronary disease. Renal dysfunction was defined as eGFR below 60 ml/min/1.73 m²; patients with eGFR below 30 ml/min/1.73 m² were excluded. At 1 year, the primary composite outcome was more frequent with renal dysfunction than without it (19.4% vs. 11.2%; unadjusted HR 1.82, 95% CI 1.13-2.94). Treatment effects did not significantly differ by renal status.
Key findings
- Among 832 patients, 108 (13%) had baseline renal dysfunction.
- The 1-year primary endpoint occurred in 19.4% with renal dysfunction versus 11.2% without it (unadjusted HR 1.82, 95% CI 1.13-2.94), primarily driven by higher death rates.
- With renal dysfunction, primary endpoint rates were 14.5% with immediate and 24.5% with staged PCI (unadjusted HR 0.55, 95% CI 0.23-1.33); no significant interaction by renal status was found.
- Baseline renal dysfunction was associated with acute renal insufficiency (adjusted HR 5.0, 95% CI 2.30-10.70, p < 0.01).
Why it matters
The analysis identifies baseline renal dysfunction as a marker of higher cardiovascular event risk and acute renal insufficiency in this STEMI population. However, it found no evidence that renal status significantly modified the relative outcomes of immediate versus staged non-culprit PCI. This distinction helps interpret renal dysfunction as a prognostic factor without assuming it establishes a preferred PCI timing strategy.
What to keep in mind
Patients with eGFR below 30 ml/min/1.73 m² were excluded, limiting applicability to severe renal dysfunction. The renal dysfunction subgroup included 108 patients, and treatment comparisons within it had wide confidence intervals.