Killip class at presentation and immediate versus staged multivessel PCI in patients with STEMI

Patients with ST-segment elevation myocardial infarction (STEMI) and higher Killip class are at an increased risk of death. We sought to assess outcomes of an immediate or staged multivessel percutaneous coronary intervention (PCI) in patients with higher Killip class presenting with STEMI and multivessel coronary artery disease (MVD). We conducted a subgroup analysis of the MULTISTARS AMI trial with stratification of patients according to Killip classes. Outcomes of patients with Killip class I and Killip class ≥ II were compared. The primary end point was a composite of all-cause death, non-fatal myocardial infarction, stroke, unplanned ischemia-driven revascularization, or hospitalization for heart failure at 1 year. The primary end point occurred in 15 (17.9%) patients with Killip class ≥ II and 78 (11.4%) patients with Killip class I (HR, 1.57 [95%CI, 0.92-2.70], p-value = 0.11). Comparing an immediate with a staged multivessel PCI strategy, the immediate strategy reduced the primary endpoint in patients with Killip class I (6.8% vs. 15.8%; HR, 0.40 [95%CI, 0.25-0.65], p-value < 0.01), whereas the difference was not significant in patients with Killip class ≥ II (20.0% vs. 15.4%; HR, 1.37 [95%CI, 0.50-3.78], p-value = 0.55). There was a significant treatment-by-subgroup interaction for the primary endpoint (P interaction = 0.029), with immediate multivessel PCI not showing an advantage in Killip class ≥ II patients. Conclusively, in the MULTISTARS AMI trial, the benefit of immediate multivessel revascularization strategy observed in patients with Killip class I appeared attenuated in those presenting with Killip class ≥ II, suggesting a potential difference in treatment effect that warrants further investigation. (Supported by Boston Scientific; MULTISTARS AMI, NCT03135275).

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Journal
Scientific Reports
Published
2026-06-26
DOI
https://doi.org/10.1038/s41598-026-58258-8
Primary Topic
Coronary Interventions and Diagnostics
Type
article
Field-Weighted Citation Impact
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article

Killip class at presentation and immediate versus staged multivessel PCI in patients with STEMI

Christian Templin, Miklós Rohla, Giorgio Quadri, Bernhard Witzenbichler et al.
Scientific Reports
Coronary Interventions and Diagnostics
article

Killip class at presentation and immediate versus staged multivessel PCI in patients with STEMI

Christian Templin, Miklós Rohla, Giorgio Quadri, Bernhard Witzenbichler, Matteo Vercellino, Adnan Kastrati, Alban Dibra, Francesco Paneni, Aurel Toma, Philipp Jakob, Greca Zanda, Moritz Seiffert, Matthias Schindler, Kurt Huber, Julia Stehli, Alessandro Candreva, Michael Würdinger, Steffen Schneider, Marco Moccetti, Stephan Achenbach, Thomas Münzel, Ian Ford, Luise Gaede, F J N Neumann, G Magnani, Christian Valina, Barbara E. Stähli, P Christian Schulze, Frank Ruschitzka, P Clemmensen, Irene M. Lang, Franz Weidinger, P N Nordbeck, N M Mangner, A Linke, T Riemer, Rahel Kesterke, Ferdinando Varbella, Karl-Ludwig Laugwitz, Mirjam Kessler, Stephan B. Felix, Wolfgang Rottbauer, Lorenz Bott-Flügel, Manfred Wischnewsky, Gert Richardt
article en

Abstract

Patients with ST-segment elevation myocardial infarction (STEMI) and higher Killip class are at an increased risk of death. We sought to assess outcomes of an immediate or staged multivessel percutaneous coronary intervention (PCI) in patients with higher Killip class presenting with STEMI and multivessel coronary artery disease (MVD). We conducted a subgroup analysis of the MULTISTARS AMI trial with stratification of patients according to Killip classes. Outcomes of patients with Killip class I and Killip class ≥ II were compared. The primary end point was a composite of all-cause death, non-fatal myocardial infarction, stroke, unplanned ischemia-driven revascularization, or hospitalization for heart failure at 1 year. The primary end point occurred in 15 (17.9%) patients with Killip class ≥ II and 78 (11.4%) patients with Killip class I (HR, 1.57 [95%CI, 0.92-2.70], p-value = 0.11). Comparing an immediate with a staged multivessel PCI strategy, the immediate strategy reduced the primary endpoint in patients with Killip class I (6.8% vs. 15.8%; HR, 0.40 [95%CI, 0.25-0.65], p-value < 0.01), whereas the difference was not significant in patients with Killip class ≥ II (20.0% vs. 15.4%; HR, 1.37 [95%CI, 0.50-3.78], p-value = 0.55). There was a significant treatment-by-subgroup interaction for the primary endpoint (P interaction = 0.029), with immediate multivessel PCI not showing an advantage in Killip class ≥ II patients. Conclusively, in the MULTISTARS AMI trial, the benefit of immediate multivessel revascularization strategy observed in patients with Killip class I appeared attenuated in those presenting with Killip class ≥ II, suggesting a potential difference in treatment effect that warrants further investigation. (Supported by Boston Scientific; MULTISTARS AMI, NCT03135275).

Scientific Reports
Roskilde University (DK), Sigmund Freud Privatuniversität Wien (AT), University of Bern (CH), University of Parma (IT), Universität Hamburg (DE), University of Freiburg (DE), University of Bremen (DE), Friedrich-Alexander-Universität Erlangen-Nürnberg (DE), Johannes Gutenberg University Mainz (DE), Universitätsmedizin Greifswald (DE), Roskilde Sygehus (DK), Mother Teresa Hospital (AL), University Hospital of Bern (CH), University Medical Center Freiburg (DE), University of Applied Management (DE), TUM Klinikum (DE), Zealand University Hospital (DK), Helios Amper-Klinikum Dachau (DE), Wilhelminen Hospital (AT), University of Applied Sciences Burgenland (AT), University Medical Center of the Johannes Gutenberg University Mainz (DE), Ente Ospedaliero Cantonale (CH), University Hospital of Zurich (CH), Starnberg Hospital (DE), University Medical Center Hamburg-Eppendorf (DE), Stiftung Institut für Herzinfarktforschung (DE), Universitätsklinikum Würzburg (DE), German Centre for Cardiovascular Research (DE), BG University Hospital Bergmannsheil Bochum (DE), Austrian Competence Centre of Food Safety (AT), Ospedale Policlinico San Martino (IT), Kantonsspital Graubünden (CH), Segeberger Kliniken (DE), Ospedale degli Infermi (IT), Medical University of Vienna (AT), Friedrich Schiller University Jena (DE), Technische Universität Dresden (DE), University of Glasgow (GB), Ruhr University Bochum (DE)
Universität Zürich
Good health and well-being
Openalex Percentile: Top 6%
Coronary Interventions and Diagnostics
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