2f:I[703058,["/_next/static/immutable/chunks/3bhq_5eh1d760.js","/_next/static/immutable/chunks/1855-ogyi8eh4.js","/_next/static/immutable/chunks/2pfsjpn6k6zlg.js","/_next/static/immutable/chunks/26c7v3_3uwnwu.js","/_next/static/immutable/chunks/25a3ozcrvi1ff.js","/_next/static/immutable/chunks/2r4wx50nvjh_4.js","/_next/static/immutable/chunks/23fsw06hsi5b1.js","/_next/static/immutable/chunks/06_yt270h41rg.js","/_next/static/immutable/chunks/3ezsiz-7shkna.js","/_next/static/immutable/chunks/20x2y96ldu5wx.js","/_next/static/immutable/chunks/2lxntcm3pd1_h.js","/_next/static/immutable/chunks/00dgco8irq3jw.js","/_next/static/immutable/chunks/00nwe-kq0rboc.js","/_next/static/immutable/chunks/2051ffx3xzio9.js"],"PaperListPageClient"] 30:T870,The optimal timing of complete revascularization in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease complicated by heart failure remains uncertain. The OPTION-STEMI (Optimal Timing of Fractional Flow Reserve-Guided Complete Revascularization for Non-Infarct-Related Artery in ST-segment Elevation Myocardial Infarction with Multivessel Disease) trial compared immediate vs staged complete revascularization during the index admission in patients with STEMI and multivessel disease. In the OPTION-STEMI trial, immediate complete revascularization was not found to be non-inferior for the primary endpoint compared with staged complete revascularization. Pre-specified subgroup analysis was performed according to heart failure at admission, defined as Killip class II or III. The primary endpoint was a composite of death from any cause, non-fatal myocardial infarction, or any unplanned revascularization at 1 year. Among 994 randomized patients, 329 (33.1%) had heart failure at admission. These patients had a higher risk of primary endpoint than those without heart failure (18.2% vs 8.7%; adjusted HR 1.63; 95% CI 1.11-2.40; P = .013). At 1 year, immediate complete revascularization was associated with a higher incidence of the primary endpoint than staged complete revascularization in patients with heart failure (22.8% vs 13.3%; HR 1.79; 95% CI 1.05-3.04), but not in those without heart failure (8.0% vs 9.5%; HR 0.84; 95% CI .50-1.40). A significant interaction was observed between heart failure status and randomized strategy (P = .043). In the OPTION-STEMI trial, among patients with STEMI and multi-vessel disease who were not in cardiogenic shock, immediate complete revascularization was not non-inferior compared with staged complete revascularization. However, subgroup analysis suggests that the worse outcomes with immediate complete revascularization may be limited to patients with heart failure at admission. Further studies are required to demonstrate the non-inferiority of immediate complete revascularization compared with staged complete revascularization in patients without heart failure.31:Tafc,Abstract Background and Aims The optimal timing of complete revascularization in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease complicated by heart failure remains uncertain. Methods The OPTION-STEMI (Optimal Timing of Fractional Flow Reserve-Guided Complete Revascularization for Non-Infarct-Related Artery in ST-segment Elevation Myocardial Infarction with Multivessel Disease) trial compared immediate vs staged complete revascularization during the index admission in patients with STEMI and multivessel disease. In the OPTION-STEMI trial, immediate complete revascularization was not found to be non-inferior for the primary endpoint compared with staged complete revascularization. Pre-specified subgroup analysis was performed according to heart failure at admission, defined as Killip class II or III. The primary endpoint was a composite of death from any cause, non-fatal myocardial infarction, or any unplanned revascularization at 1 year. Results Among 994 randomized patients, 329 (33.1%) had heart failure at admission. These patients had a higher risk of primary endpoint than those without heart failure (18.2% vs 8.7%; adjusted HR 1.63; 95% CI 1.11–2.40; P = .013). At 1 year, immediate complete revascularization was associated with a higher incidence of the primary endpoint than staged complete revascularization in patients with heart failure (22.8% vs 13.3%; HR 1.79; 95% CI 1.05–3.04), but not in those without heart failure (8.0% vs 9.5%; HR 0.84; 95% CI .50–1.40). A significant interaction was observed between heart failure status and randomized strategy (P = .043). Conclusions In the OPTION-STEMI trial, among patients with STEMI and multi-vessel disease who were not in cardiogenic shock, immediate complete revascularization was not non-inferior compared with staged complete revascularization. However, subgroup analysis suggests that the worse outcomes with immediate complete revascularization may be limited to patients with heart failure at admission. Further studies are required to demonstrate the non-inferiority of immediate complete revascularization compared with staged complete revascularization in patients without heart failure. 25:[[["$","script","0",{"type":"application/ld+json","dangerouslySetInnerHTML":{"__html":"{\"@context\":\"https://schema.org\",\"@type\":\"CollectionPage\",\"name\":\"ST-Segment Elevation Myocardial Infarction: condition Research & Clinical Takeaways\",\"description\":\"Explore peer-reviewed papers on ST-Segment Elevation Myocardial Infarction (condition). 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Thirty-day MACE trended lower with POP (2.0% vs. 4.1%; HR 0.49; P=0.15) but did not reach significance.","limitations":"- Short follow-up (median 30 days) limits assessment of longer-term clinical outcomes such as mortality or target vessel failure.\n- The MACE reduction was numerically large but underpowered to reach statistical significance (P=0.15), so clinical benefit remains uncertain.\n- Blinding was at the endpoint assessment level only; operators were unblinded, introducing potential performance bias.","practice_takeaway":"In STEMI patients undergoing primary PCI, maintaining stent inflation pressure ≥14 atm until pressure stabilizes improves reperfusion success and reduces the need for postdilation compared to rapid deflation — consider adopting POP as a default technique while awaiting larger trials to confirm MACE benefit."}},{"doi":"10.1093/eurheartj/ehaf924","pmid":"41493330","title":"Complete revascularization timing in ST-segment elevation myocardial infarction and multivessel disease with heart failure: the OPTION–STEMI trial","journal_title":"European Heart Journal","journal_issn":"0195-668X","published_at":"2026-01-06T00:00:00.000Z","url":"https://doi.org/10.1093/eurheartj/ehaf924","source_score":26,"is_retracted":false,"is_open_access":false,"raw_metadata":{"ooir":{"day":"2026-01-07","doi":"10.1093/eurheartj/ehaf924","days":"7","issn":"0195-668X","rank":"7","field":"Clinical Medicine","score":"26","category":"Cardiac & Cardiovascular Systems","categories":["Cardiac & Cardiovascular Systems"],"_categories":["Cardiac & Cardiovascular Systems"]},"pubmed":{"doi":"10.1093/eurheartj/ehaf924","title":"Complete revascularization timing in ST-segment elevation myocardial infarction and multivessel disease with heart failure: the OPTION-STEMI trial.","journal":"European heart journal","methods":"","results":"Among 994 randomized patients, 329 (33.1%) had heart failure at admission. These patients had a higher risk of primary endpoint than those without heart failure (18.2% vs 8.7%; adjusted HR 1.63; 95% CI 1.11-2.40; P = .013). At 1 year, immediate complete revascularization was associated with a higher incidence of the primary endpoint than staged complete revascularization in patients with heart failure (22.8% vs 13.3%; HR 1.79; 95% CI 1.05-3.04), but not in those without heart failure (8.0% vs 9.5%; HR 0.84; 95% CI .50-1.40). A significant interaction was observed between heart failure status and randomized strategy (P = .043).","abstract":"$30","keywords":["Heart failure","Multivessel coronary artery disease","Percutaneous coronary intervention","ST-segment elevation myocardial 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Infarction","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehaf924","tag_type":"impact_flag","value":"safety_signal","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehaf924","tag_type":"level_of_evidence","value":"2","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehaf924","tag_type":"modality","value":"Percutaneous Coronary Intervention","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehaf924","tag_type":"sample_size","value":"n=994","value_numeric":994},{"paper_doi":"10.1093/eurheartj/ehaf924","tag_type":"study_design","value":"Randomized Controlled Trial","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehaf924","tag_type":"warning","value":"Non-inferiority margin and full arm-level event data are not detailed in the provided text.","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehaf924","tag_type":"warning","value":"Patients in cardiogenic shock were excluded, so results do not apply to that group.","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehaf924","tag_type":"warning","value":"The main signal favoring staged revascularization in heart failure is from a pre-specified subgroup analysis.","value_numeric":null}],"summaries":{"what_studied":"A randomized trial compared immediate versus staged fractional flow reserve–guided complete revascularization during the index admission in STEMI with multivessel disease, excluding cardiogenic shock. A pre-specified subgroup by heart failure at admission (Killip II–III) assessed a 1-year composite of all-cause death, non-fatal MI, or unplanned revascularization.","key_result":"Immediate complete revascularization was not non-inferior to staged overall. Among 994 patients, 329 (33.1%) had heart failure and had more primary events than those without heart failure (18.2% vs 8.7%; adjusted HR 1.63; 95% CI 1.11–2.40; P=.013). In heart failure, immediate vs staged had higher events (22.8% vs 13.3%; HR 1.79; 95% CI 1.05–3.04); without heart failure, events were similar (8.0% vs 9.5%; HR 0.84; 95% CI 0.50–1.40). Interaction P=.043.","limitations":"The differential effect by heart failure status comes from a subgroup analysis. Cardiogenic shock was excluded, limiting generalizability. The non-inferiority margin and overall arm-level event counts are not provided here.","practice_takeaway":"For STEMI with multivessel disease and heart failure at admission (Killip II–III) without shock, staged complete revascularization during the index admission had better 1-year outcomes than immediate. In those without heart failure, immediate and staged strategies showed similar 1-year outcomes; further confirmation is needed."}}],"initialOffset":2,"fetchConfig":{"kind":"tags","tags":[{"tag_type":"condition","value":"ST-Segment Elevation Myocardial Infarction"}]},"breadcrumbItems":[{"name":"Home","href":"/"},{"name":"Research Hub","href":"/hub"},{"name":"Conditions","href":"/hub/tag/condition"},{"name":"ST-Segment Elevation Myocardial Infarction"}],"hrefConfig":{"basePath":"/hub/papers","webViewQueryParams":{"hub_ctx":"tag","hub_tag_type":"condition","hub_tag_value":"ST-Segment Elevation Myocardial Infarction"}}}]]

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