Tags

Type your tag names separated by a space and hit enter

Impact of multivessel disease on reperfusion success and clinical outcomes in patients undergoing primary percutaneous coronary intervention for acute myocardial infarction.
Eur Heart J. 2007 Jul; 28(14):1709-16.EH

Abstract

AIMS

We sought to investigate the impact of multivessel coronary artery disease (CAD) on reperfusion success and prognosis following primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI). The influence of multivessel disease on myocardial reperfusion and subsequent survival after primary PCI has not been studied.

METHODS AND RESULTS

In the CADILLAC trial, primary PCI was performed in 2082 patients of any age with AMI within 12 h of symptom onset. Myocardial perfusion post-PCI assessed by ST-segment recovery and myocardial blush and clinical outcomes were stratified by the extent of CAD. Single-, double-, and triple-vessel disease were present in 1066 (51.2%), 692 (33.2%), and 324 (15.6%) patients, respectively. Patients with multivessel disease compared with those with single-vessel disease undergoing primary PCI were significantly more likely to have absent ST-segment recovery (13.3 vs. 7.4%, P = 0.01), though the rates of post-procedural TIMI-3 flow (89.7 vs. 88.9%, P = 0.66) and grade 2 or 3 myocardial blush (51.2 vs. 51.5%, P = 0.91) in the infarct vessel were comparable. By 1 year, the cumulative incidence of death for patients with single-, double-, and triple-vessel disease was 3.2, 4.4, and 7.8%, respectively (P = 0.003), and the composite rate of major adverse cardiac events (MACE) was 14.8, 19.5, and 23.6%, respectively (P = 0.0006). By multivariable analysis, the presence of triple-vessel disease was the strongest predictor of 1-year death [hazard ratio (HR) = 2.60, P = 0.009], death and re-infarction (HR = 1.88, P = 0.03), and MACE (HR = 1.80, P = 0.0009).

CONCLUSION

Patients with extensive CAD in vessels remote from the infarct-related artery have reduced reperfusion success and an adverse prognosis following primary PCI in AMI. Future studies regarding the optimal treatment of patients with multivessel disease and AMI are warranted.

Authors+Show Affiliations

Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN, 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 availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial

Language

eng

PubMed ID

17556348

Citation

Sorajja, Paul, et al. "Impact of Multivessel Disease On Reperfusion Success and Clinical Outcomes in Patients Undergoing Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction." European Heart Journal, vol. 28, no. 14, 2007, pp. 1709-16.
Sorajja P, Gersh BJ, Cox DA, et al. Impact of multivessel disease on reperfusion success and clinical outcomes in patients undergoing primary percutaneous coronary intervention for acute myocardial infarction. Eur Heart J. 2007;28(14):1709-16.
Sorajja, P., Gersh, B. J., Cox, D. A., McLaughlin, M. G., Zimetbaum, P., Costantini, C., Stuckey, T., Tcheng, J. E., Mehran, R., Lansky, A. J., Grines, C. L., & Stone, G. W. (2007). Impact of multivessel disease on reperfusion success and clinical outcomes in patients undergoing primary percutaneous coronary intervention for acute myocardial infarction. European Heart Journal, 28(14), 1709-16.
Sorajja P, et al. Impact of Multivessel Disease On Reperfusion Success and Clinical Outcomes in Patients Undergoing Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction. Eur Heart J. 2007;28(14):1709-16. PubMed PMID: 17556348.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of multivessel disease on reperfusion success and clinical outcomes in patients undergoing primary percutaneous coronary intervention for acute myocardial infarction. AU - Sorajja,Paul, AU - Gersh,Bernard J, AU - Cox,David A, AU - McLaughlin,Michael G, AU - Zimetbaum,Peter, AU - Costantini,Costantino, AU - Stuckey,Thomas, AU - Tcheng,James E, AU - Mehran,Roxana, AU - Lansky,Alexandra J, AU - Grines,Cindy L, AU - Stone,Gregg W, Y1 - 2007/06/07/ PY - 2007/6/9/pubmed PY - 2008/2/28/medline PY - 2007/6/9/entrez SP - 1709 EP - 16 JF - European heart journal JO - Eur Heart J VL - 28 IS - 14 N2 - AIMS: We sought to investigate the impact of multivessel coronary artery disease (CAD) on reperfusion success and prognosis following primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI). The influence of multivessel disease on myocardial reperfusion and subsequent survival after primary PCI has not been studied. METHODS AND RESULTS: In the CADILLAC trial, primary PCI was performed in 2082 patients of any age with AMI within 12 h of symptom onset. Myocardial perfusion post-PCI assessed by ST-segment recovery and myocardial blush and clinical outcomes were stratified by the extent of CAD. Single-, double-, and triple-vessel disease were present in 1066 (51.2%), 692 (33.2%), and 324 (15.6%) patients, respectively. Patients with multivessel disease compared with those with single-vessel disease undergoing primary PCI were significantly more likely to have absent ST-segment recovery (13.3 vs. 7.4%, P = 0.01), though the rates of post-procedural TIMI-3 flow (89.7 vs. 88.9%, P = 0.66) and grade 2 or 3 myocardial blush (51.2 vs. 51.5%, P = 0.91) in the infarct vessel were comparable. By 1 year, the cumulative incidence of death for patients with single-, double-, and triple-vessel disease was 3.2, 4.4, and 7.8%, respectively (P = 0.003), and the composite rate of major adverse cardiac events (MACE) was 14.8, 19.5, and 23.6%, respectively (P = 0.0006). By multivariable analysis, the presence of triple-vessel disease was the strongest predictor of 1-year death [hazard ratio (HR) = 2.60, P = 0.009], death and re-infarction (HR = 1.88, P = 0.03), and MACE (HR = 1.80, P = 0.0009). CONCLUSION: Patients with extensive CAD in vessels remote from the infarct-related artery have reduced reperfusion success and an adverse prognosis following primary PCI in AMI. Future studies regarding the optimal treatment of patients with multivessel disease and AMI are warranted. SN - 0195-668X UR - https://www.unboundmedicine.com/medline/citation/17556348/Impact_of_multivessel_disease_on_reperfusion_success_and_clinical_outcomes_in_patients_undergoing_primary_percutaneous_coronary_intervention_for_acute_myocardial_infarction_ L2 - https://academic.oup.com/eurheartj/article-lookup/doi/10.1093/eurheartj/ehm184 DB - PRIME DP - Unbound Medicine ER -