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Multivessel percutaneous coronary intervention in patients with multivessel disease and acute myocardial infarction.
Am Heart J. 2004 Sep; 148(3):493-500.AH

Abstract

BACKGROUND

The optimal percutaneous interventional strategy for dealing with significant non-culprit lesions in patients with multivessel disease (MVD) with acute myocardial infarction (AMI) at presentation remains controversial.

METHODS

A total of 820 patients treated with primary angioplasty for AMI between 1998 and 2002 were classified in groups of patients with single vessel disease (SVD) or MVD (> or =70% stenosis of > or =2 coronary arteries). Patients with MVD were subdivided in 3 groups on the basis of the revascularization strategy: 1) patients undergoing percutaneous coronary intervention (PCI) of the infarct-related artery (IRA) only; 2) patients undergoing PCI of both the IRA and non-IRA(s) during the initial procedure; and 3) patients undergoing PCI of the IRA followed by staged, in-hospital PCI of the non-IRA(s). Procedural, 30-day, and 1-year outcomes are reported.

RESULTS

At 1 year, compared with patients with SVD, patients with MVD had a higher incidence of re-infarction (5.9% vs 1.6%, P =.003), revascularization (18% vs 9.6%, P <.001), mortality (12% vs 3.2%, P <.001), and major adverse cardiac events (MACEs; 31% vs 13%, P <.001). In patients with MVD, compared with PCI restricted to the IRA only, multivessel PCI was associated with higher rates of re-infarction (13.0% vs 2.8%, P <.001), revascularization (25% vs 15%, P =.007), and MACEs (40% vs 28%, P =.006). Multivessel PCI was an independent predictor of MACEs at 1 year (odds ratio = 1.67, P =.01).

CONCLUSIONS

These data suggest that in patients with MVD, PCI should be directed at the IRA only, with decisions about PCI of non-culprit lesions guided by objective evidence of residual ischemia at late follow-up. Further studies are needed to confirm these findings.

Authors+Show Affiliations

Section of Cardiology, Biostatistics, and Outcomes Research, Mid America Heart Institute, St. Luke's Hospital, Kansas City, Mo 64111, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article

Language

eng

PubMed ID

15389238

Citation

Corpus, Roberto A., et al. "Multivessel Percutaneous Coronary Intervention in Patients With Multivessel Disease and Acute Myocardial Infarction." American Heart Journal, vol. 148, no. 3, 2004, pp. 493-500.
Corpus RA, House JA, Marso SP, et al. Multivessel percutaneous coronary intervention in patients with multivessel disease and acute myocardial infarction. Am Heart J. 2004;148(3):493-500.
Corpus, R. A., House, J. A., Marso, S. P., Grantham, J. A., Huber, K. C., Laster, S. B., Johnson, W. L., Daniels, W. C., Barth, C. W., Giorgi, L. V., & Rutherford, B. D. (2004). Multivessel percutaneous coronary intervention in patients with multivessel disease and acute myocardial infarction. American Heart Journal, 148(3), 493-500.
Corpus RA, et al. Multivessel Percutaneous Coronary Intervention in Patients With Multivessel Disease and Acute Myocardial Infarction. Am Heart J. 2004;148(3):493-500. PubMed PMID: 15389238.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Multivessel percutaneous coronary intervention in patients with multivessel disease and acute myocardial infarction. AU - Corpus,Roberto A, AU - House,John A, AU - Marso,Steven P, AU - Grantham,J Aaron, AU - Huber,Kenneth C,Jr AU - Laster,Steven B, AU - Johnson,Warren L, AU - Daniels,William C, AU - Barth,Charles W, AU - Giorgi,Lee V, AU - Rutherford,Barry D, PY - 2004/9/25/pubmed PY - 2004/12/17/medline PY - 2004/9/25/entrez SP - 493 EP - 500 JF - American heart journal JO - Am Heart J VL - 148 IS - 3 N2 - BACKGROUND: The optimal percutaneous interventional strategy for dealing with significant non-culprit lesions in patients with multivessel disease (MVD) with acute myocardial infarction (AMI) at presentation remains controversial. METHODS: A total of 820 patients treated with primary angioplasty for AMI between 1998 and 2002 were classified in groups of patients with single vessel disease (SVD) or MVD (> or =70% stenosis of > or =2 coronary arteries). Patients with MVD were subdivided in 3 groups on the basis of the revascularization strategy: 1) patients undergoing percutaneous coronary intervention (PCI) of the infarct-related artery (IRA) only; 2) patients undergoing PCI of both the IRA and non-IRA(s) during the initial procedure; and 3) patients undergoing PCI of the IRA followed by staged, in-hospital PCI of the non-IRA(s). Procedural, 30-day, and 1-year outcomes are reported. RESULTS: At 1 year, compared with patients with SVD, patients with MVD had a higher incidence of re-infarction (5.9% vs 1.6%, P =.003), revascularization (18% vs 9.6%, P <.001), mortality (12% vs 3.2%, P <.001), and major adverse cardiac events (MACEs; 31% vs 13%, P <.001). In patients with MVD, compared with PCI restricted to the IRA only, multivessel PCI was associated with higher rates of re-infarction (13.0% vs 2.8%, P <.001), revascularization (25% vs 15%, P =.007), and MACEs (40% vs 28%, P =.006). Multivessel PCI was an independent predictor of MACEs at 1 year (odds ratio = 1.67, P =.01). CONCLUSIONS: These data suggest that in patients with MVD, PCI should be directed at the IRA only, with decisions about PCI of non-culprit lesions guided by objective evidence of residual ischemia at late follow-up. Further studies are needed to confirm these findings. SN - 1097-6744 UR - https://www.unboundmedicine.com/medline/citation/15389238/Multivessel_percutaneous_coronary_intervention_in_patients_with_multivessel_disease_and_acute_myocardial_infarction_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002870304002650 DB - PRIME DP - Unbound Medicine ER -