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Prevalence, predictors, and in-hospital outcomes of non-infarct artery intervention during primary percutaneous coronary intervention for ST-segment elevation myocardial infarction (from the National Cardiovascular Data Registry).
Am J Cardiol. 2009 Aug 15; 104(4):507-13.AJ

Abstract

Guidelines support percutaneous coronary intervention (PCI) of the noninfarct-related artery during primary PCI for ST-segment elevation myocardial infarction (STEMI) in patients with hemodynamic compromise; however, in patients without hemodynamic compromise, PCI of the noninfarct-related artery is given a class III recommendation. We analyzed the National Cardiovascular Data Registry (n = 708,481 admissions, 638 sites) to determine the prevalence, predictors, and in-hospital outcomes of primary multivessel PCI from 2004 to 2007. Patients with STEMI and multivessel coronary artery disease who were undergoing primary PCI were identified (n = 31,681). After excluding the patients treated with staged PCI (n = 2,745), 10.8% (n = 3,134) of the remaining population (n = 28,936) were treated with multivessel PCI. Patients undergoing multivessel PCI were at higher risk and were more likely to be in cardiogenic shock. The overall in-hospital mortality rates were greater in patients undergoing multivessel PCI (7.9% vs 5.1%, p <0.01). Among patients with STEMI and cardiogenic shock (n = 3,087), those receiving multivessel PCI had greater in-hospital mortality (36.5% vs 27.8%; adjusted odds ratio 1.54, 95% confidence interval 1.22 to 1.95). In conclusion, these data suggest that performing multivessel PCI during primary PCI for STEMI does not improve short-term survival even for patients with cardiogenic shock. These findings suggest the need for definitive studies to evaluate the utility of noninfarct-related artery PCI among patients with STEMI.

Authors+Show Affiliations

Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA. matt.cavender@gmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19660603

Citation

Cavender, Matthew A., et al. "Prevalence, Predictors, and In-hospital Outcomes of Non-infarct Artery Intervention During Primary Percutaneous Coronary Intervention for ST-segment Elevation Myocardial Infarction (from the National Cardiovascular Data Registry)." The American Journal of Cardiology, vol. 104, no. 4, 2009, pp. 507-13.
Cavender MA, Milford-Beland S, Roe MT, et al. Prevalence, predictors, and in-hospital outcomes of non-infarct artery intervention during primary percutaneous coronary intervention for ST-segment elevation myocardial infarction (from the National Cardiovascular Data Registry). Am J Cardiol. 2009;104(4):507-13.
Cavender, M. A., Milford-Beland, S., Roe, M. T., Peterson, E. D., Weintraub, W. S., & Rao, S. V. (2009). Prevalence, predictors, and in-hospital outcomes of non-infarct artery intervention during primary percutaneous coronary intervention for ST-segment elevation myocardial infarction (from the National Cardiovascular Data Registry). The American Journal of Cardiology, 104(4), 507-13. https://doi.org/10.1016/j.amjcard.2009.04.016
Cavender MA, et al. Prevalence, Predictors, and In-hospital Outcomes of Non-infarct Artery Intervention During Primary Percutaneous Coronary Intervention for ST-segment Elevation Myocardial Infarction (from the National Cardiovascular Data Registry). Am J Cardiol. 2009 Aug 15;104(4):507-13. PubMed PMID: 19660603.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prevalence, predictors, and in-hospital outcomes of non-infarct artery intervention during primary percutaneous coronary intervention for ST-segment elevation myocardial infarction (from the National Cardiovascular Data Registry). AU - Cavender,Matthew A, AU - Milford-Beland,Sarah, AU - Roe,Matthew T, AU - Peterson,Eric D, AU - Weintraub,William S, AU - Rao,Sunil V, Y1 - 2009/06/18/ PY - 2009/02/20/received PY - 2009/04/02/revised PY - 2009/04/02/accepted PY - 2009/8/8/entrez PY - 2009/8/8/pubmed PY - 2009/8/28/medline SP - 507 EP - 13 JF - The American journal of cardiology JO - Am J Cardiol VL - 104 IS - 4 N2 - Guidelines support percutaneous coronary intervention (PCI) of the noninfarct-related artery during primary PCI for ST-segment elevation myocardial infarction (STEMI) in patients with hemodynamic compromise; however, in patients without hemodynamic compromise, PCI of the noninfarct-related artery is given a class III recommendation. We analyzed the National Cardiovascular Data Registry (n = 708,481 admissions, 638 sites) to determine the prevalence, predictors, and in-hospital outcomes of primary multivessel PCI from 2004 to 2007. Patients with STEMI and multivessel coronary artery disease who were undergoing primary PCI were identified (n = 31,681). After excluding the patients treated with staged PCI (n = 2,745), 10.8% (n = 3,134) of the remaining population (n = 28,936) were treated with multivessel PCI. Patients undergoing multivessel PCI were at higher risk and were more likely to be in cardiogenic shock. The overall in-hospital mortality rates were greater in patients undergoing multivessel PCI (7.9% vs 5.1%, p <0.01). Among patients with STEMI and cardiogenic shock (n = 3,087), those receiving multivessel PCI had greater in-hospital mortality (36.5% vs 27.8%; adjusted odds ratio 1.54, 95% confidence interval 1.22 to 1.95). In conclusion, these data suggest that performing multivessel PCI during primary PCI for STEMI does not improve short-term survival even for patients with cardiogenic shock. These findings suggest the need for definitive studies to evaluate the utility of noninfarct-related artery PCI among patients with STEMI. SN - 1879-1913 UR - https://www.unboundmedicine.com/medline/citation/19660603/Prevalence_predictors_and_in_hospital_outcomes_of_non_infarct_artery_intervention_during_primary_percutaneous_coronary_intervention_for_ST_segment_elevation_myocardial_infarction__from_the_National_Cardiovascular_Data_Registry__ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9149(09)00919-9 DB - PRIME DP - Unbound Medicine ER -