MULTivessel Immediate Versus STAged RevaScularization in Acute Myocardial Infarction -The MULTISTARS AMI Trial
MULTivessel Immediate Versus STAged RevaScularization in Acute Myocardial Infarction -The MULTISTARS AMI Trial
The primary objective of the trial is to compare, in patients presenting with ST segment
 elevation myocardial infarction (STEMI) and multi-vessel disease (MVD), the safety and
 efficacy of immediate complete revascularization of all significant coronary lesions versus
 culprit vessel only revascularization and staged percutaneous coronary intervention (PCI) of
 all significant coronary lesions (within 19 to 45 days), in a non-inferiority trial using a
 third generation, biodegradable-polymer, everolimus-eluting stent.
An investigator-initiated, randomized, multicenter, two-arm, open-label study of consecutive
 patients presenting with STEMI and MVD in stable hemodynamic conditions, undergoing after
 successful PCI of the culprit lesion either (1:1 randomization) immediate revascularization
 of all additional target lesions during the index procedure or staged PCI of all additional
 target lesions (within 19 to 45 days) using the Boston Scientific Synergy™ stent.

 The goal of this trial is to compare two treatment strategies that are currently performed in
 clinical practice: immediate complete revascularization versus staged complete
 revascularization in patients with STEMI and MVD.

 Patients randomized to immediate complete revascularization will have treated during the
 index procedure, after revascularization of the culprit lesion, all significant non-culprit
 coronary lesions.

 Patients randomized to staged complete revascularization will have treated during the index
 procedure only the culprit lesion, and they will be hospitalized after 19-45 days for
 complete revascularization of all significant non-culprit coronary lesions.

 For both groups, lesion are considered significant when causing a ≥70% diameter stenosis by
 visual estimation in at least two projections on the coronary angiogram.
Inclusion Criteria:

 -  Age ≥ 18 years

 -  Spontaneous acute STEMI (patients presenting within 24 hours of symptom onset)

 -  Suitability for PCI from femoral or radial access

 -  Coronary anatomy suitable for complete coronary revascularization with Synergy® stent
 implantation

 -  Identifiable culprit lesion/artery

 -  At least one non-culprit coronary stenosis ≥ 70% in at least two projections, in a
 vessel with a lumen diameter ≥2.25 - ≤5.75 mm, other than the culprit artery

 -  TIMI Flow 3 or TIMI flow 2 after revascularization of the culprit artery

 -  Stable hemodynamics at the end of the culprit vessel revascularization

 Exclusion Criteria:

 -  Inability to give informed consent

 -  Cardiogenic shock

 -  Prolonged resuscitation >10 min

 -  General unsuitability for PCI

 -  Need for emergency CABG

 -  Previous CABG

 -  Planned hybrid revascularization

 -  Coronary artery dissection

 -  Stent thrombosis

 -  Instent restenosis

 -  Previous documented allergic reaction to everolimus or to any stent material

 -  Severe mechanical complication of acute myocardial infarction

 -  Pre-existing severe renal failure (eGFR <30 mL/min) or dialysis

 -  Chronic total occlusion of a major coronary artery

 -  Left main stem stenosis ≥50% or left main stem equivalent (ostial left anterior
 descending and ostial circumflex stenosis ≥70%)

 -  panned coronary, cerebrovascular, or peripheral arterial revascularization

 -  Planned cardiac or major surgery

 -  Any contraindications for dual antiplatelet therapy with aspirin and a P2Y12 Inhibitor
 for at least 90 days, except for patients on oral anticoagulation

 -  Known pregnancy at the time of inclusion

 -  Participation in another clinical study with an investigational product

 -  Life expectancy <1 year