Noninfarct-related artery (non-IRA) revascularization in patients with STEMI and multivessel coronary artery disease (CAD) increased modestly from 2018 to 2022; however, a majority of patients did not undergo non-IRA PCI within 45 days of primary PCI, according to a recent study published in Circulation: Cardiovascular Interventions.

Including 349,040 index PCI procedures of patients with STEMI from the ACC's CathPCI Registry, Sanket Shishir Dhruva, MD, MHS, FACC, et al., found that 128,324 (36.8%) had multivessel CAD. The primary outcome was non-IRA PCI within 45 days after STEMI admission.

The authors observed the primary outcome in 42,437 (33.1%) patients. The rate of non-IRA PCI in patients with STEMI and multivessel CAD grew from 31.9% in the second quarter of 2018 to 34.5% in the third quarter of 2022. There was no difference in the rate of non-IRA PCI at the index PCI, indicating most of the increase occurred after the STEMI hospitalization. Non-IRA PCI rates varied significantly by hospital during index PCI (median: 9.3% [IQR, 4.7% to 16.1%]), during index PCI or hospitalization (median: 31.9% [IQR, 16.7% to 34.2%]) or at any time within 45 days (median: 31.9% [IQR, 23.8% to 41%]).

Additionally, the authors explored whether patients presenting with STEMI during business hours vs. nonbusiness hours had an impact. Of the patients whose index PCI began during normal business hours, 11.1% underwent non-IRA PCI during the index procedure vs. 10.6% during nonbusiness hours (odds ratio [OR], 0.95 [95% CI, 0.91-0.98]). No difference was seen among those who underwent non-IRA PCI at any time within 45 days (OR, 0.98 [95% CI, 0.96-1.01]).

"Overall, despite a slight increase in non-IRA PCI through 2022, less than 40% of patients received it," write the authors. "Significant practice pattern variation indicates an opportunity for implementation strategies for best practices in management."