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

Jakob P, Varbella F, Linke A, Felix SB, Seiffert M, Kesterke R, Nordbeck P, Witzenbichler B, Lang IM, Kessler M, Valina C, Dibra A, Rohla M, Moccetti M, Vercellino M, Gaede L, Bott-Flügel L, Stehli J, Candreva A, Würdinger M, Paneni F, Templin C, Schindler M, Wischnewsky M, Zanda G, Quadri G, Mangner N, Toma A, Magnani G, Clemmensen P, Münzel T, Schulze PC, Laugwitz KL, Rottbauer W, Huber K, Neumann FJ, Schneider S, Riemer T, Weidinger F, Achenbach S, Richardt G, Kastrati A, Ford I, Ruschitzka F, Stähli BE (2026)

Publication Type: Journal article

Publication year: 2026

Journal

Book Volume: 16

Article Number: 29396

Journal Issue: 1

DOI: 10.1038/s41598-026-58258-8

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)

Authors with CRIS profile

Involved external institutions

Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil Germany (DE) Universitätsspital Zürich (USZ) Switzerland (CH) Universität Bremen Germany (DE) University of Glasgow United Kingdom (GB) Universitätsklinikum Carl Gustav Carus Dresden Germany (DE) Universitätsmedizin Greifswald / Universitätsklinikum Greifswald Germany (DE) Universitätsklinikum Würzburg Germany (DE) HELIOS Kliniken Germany (DE) Medizinische Universität Wien Austria (AT) Universität Ulm Germany (DE) Universitätsklinikum Freiburg Germany (DE) University of Medicine / Universiteti i Mjekësisë Albania (AL) Sigmund-Freud-Privatuniversität Wien (SFU) / Sigmund Freud University Austria (AT) Cardiocentro Ticino Switzerland (CH) IRCCS Azienda Ospedaliera Metropolitana AOM Italy (IT) Starnberger Kliniken Germany (DE) Klinikum Landkreis Erding Germany (DE) Azienda Ospedaliero-Universitaria di Parma / Parma University Hospital Italy (IT) Universitätsklinikum Hamburg-Eppendorf (UKE) Germany (DE) Universitätsmedizin der Johannes Gutenberg-Universität Mainz Germany (DE) Universitätsklinikum Jena Germany (DE) Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK e.V.) Germany (DE) Fachhochschule Burgenland Austria (AT) IHF GmbH Institut für Herzinfarktforschung Germany (DE) Klinik Landstraße (ehem. Krankenanstalt Rudolfstiftung) Austria (AT) Universitätsklinikum Schleswig-Holstein (UKSH) Germany (DE)

How to cite

APA:

Jakob, P., Varbella, F., Linke, A., Felix, S.B., Seiffert, M., Kesterke, R.,... Stähli, B.E. (2026). Killip class at presentation and immediate versus staged multivessel PCI in patients with STEMI. Scientific Reports, 16(1). https://doi.org/10.1038/s41598-026-58258-8

MLA:

Jakob, Philipp, et al. "Killip class at presentation and immediate versus staged multivessel PCI in patients with STEMI." Scientific Reports 16.1 (2026).

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