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Prognostic impact of staged versus "one-time" multivessel percutaneous intervention in acute myocardial infarction: analysis from the HORIZONS-AMI (harmonizing outcomes with revascularization and stents in acute myocardial infarction) trial.
J Am Coll Cardiol. 2011 Aug 09; 58(7):704-11.JACC

Abstract

OBJECTIVES

The purpose of this study was to compare a one-time primary percutaneous coronary intervention (PCI) of the culprit and nonculprit lesions with PCI of only the culprit lesion and staged nonculprit PCI at a later date in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease.

BACKGROUND

In patients with STEMI and multivessel disease, it is unknown whether it is safe or even desirable to also treat the nonculprit vessel during the primary PCI procedure.

METHODS

In the HORIZONS-AMI (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction) trial, 668 of the 3,602 STEMI patients enrolled (18.5%) underwent PCI of culprit and nonculprit lesions for multivessel disease. Patients were categorized into a single PCI strategy (n = 275) versus staged PCI (n = 393). The endpoints analyzed included the 1-year rates of major adverse cardiovascular events and its components, death, reinfarction, target-vessel revascularization for ischemia, and stroke.

RESULTS

Single versus staged PCI was associated with higher 1-year mortality (9.2% vs. 2.3%; hazard ratio [HR]: 4.1, 95% confidence interval [CI]: 1.93 to 8.86, p < 0.0001), cardiac mortality (6.2% vs. 2.0%; HR: 3.14, 95% CI: 1.35 to 7.27, p = 0.005), definite/probable stent thrombosis (5.7% vs. 2.3%; HR: 2.49, 95% CI: 1.09 to 5.70, p = 0.02), and a trend toward greater major adverse cardiovascular events (18.1% vs. 13.4%; HR: 1.42, 95% CI: 0.96 to 2.1, p = 0.08). The mortality advantage favoring staged PCI was maintained in a subgroup of patients undergoing truly elective multivessel PCI. Also, the staged PCI strategy was independently associated with lower all-cause mortality at 30 days and at 1 year.

CONCLUSIONS

A deferred angioplasty strategy of nonculprit lesions should remain the standard approach in patients with STEMI undergoing primary PCI, as multivessel PCI may be associated with a greater hazard for mortality and stent thrombosis. (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction [HORIZONS-AMI]; NCT00433966).

Authors+Show Affiliations

Rabin Medical Center, Petach Tikva, Israel, and Tel Aviv University, Tel Aviv, Israel. ran.kornowski@gmail.comNo 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 availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21816305

Citation

Kornowski, Ran, et al. "Prognostic Impact of Staged Versus "one-time" Multivessel Percutaneous Intervention in Acute Myocardial Infarction: Analysis From the HORIZONS-AMI (harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction) Trial." Journal of the American College of Cardiology, vol. 58, no. 7, 2011, pp. 704-11.
Kornowski R, Mehran R, Dangas G, et al. Prognostic impact of staged versus "one-time" multivessel percutaneous intervention in acute myocardial infarction: analysis from the HORIZONS-AMI (harmonizing outcomes with revascularization and stents in acute myocardial infarction) trial. J Am Coll Cardiol. 2011;58(7):704-11.
Kornowski, R., Mehran, R., Dangas, G., Nikolsky, E., Assali, A., Claessen, B. E., Gersh, B. J., Wong, S. C., Witzenbichler, B., Guagliumi, G., Dudek, D., Fahy, M., Lansky, A. J., & Stone, G. W. (2011). Prognostic impact of staged versus "one-time" multivessel percutaneous intervention in acute myocardial infarction: analysis from the HORIZONS-AMI (harmonizing outcomes with revascularization and stents in acute myocardial infarction) trial. Journal of the American College of Cardiology, 58(7), 704-11. https://doi.org/10.1016/j.jacc.2011.02.071
Kornowski R, et al. Prognostic Impact of Staged Versus "one-time" Multivessel Percutaneous Intervention in Acute Myocardial Infarction: Analysis From the HORIZONS-AMI (harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction) Trial. J Am Coll Cardiol. 2011 Aug 9;58(7):704-11. PubMed PMID: 21816305.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prognostic impact of staged versus "one-time" multivessel percutaneous intervention in acute myocardial infarction: analysis from the HORIZONS-AMI (harmonizing outcomes with revascularization and stents in acute myocardial infarction) trial. AU - Kornowski,Ran, AU - Mehran,Roxana, AU - Dangas,George, AU - Nikolsky,Eugenia, AU - Assali,Abid, AU - Claessen,Bimmer E, AU - Gersh,Bernard J, AU - Wong,S Chiu, AU - Witzenbichler,Bernhard, AU - Guagliumi,Giulio, AU - Dudek,Dariusz, AU - Fahy,Martin, AU - Lansky,Alexandra J, AU - Stone,Gregg W, AU - ,, PY - 2010/09/19/received PY - 2011/02/14/revised PY - 2011/02/22/accepted PY - 2011/8/6/entrez PY - 2011/8/6/pubmed PY - 2011/10/5/medline SP - 704 EP - 11 JF - Journal of the American College of Cardiology JO - J Am Coll Cardiol VL - 58 IS - 7 N2 - OBJECTIVES: The purpose of this study was to compare a one-time primary percutaneous coronary intervention (PCI) of the culprit and nonculprit lesions with PCI of only the culprit lesion and staged nonculprit PCI at a later date in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease. BACKGROUND: In patients with STEMI and multivessel disease, it is unknown whether it is safe or even desirable to also treat the nonculprit vessel during the primary PCI procedure. METHODS: In the HORIZONS-AMI (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction) trial, 668 of the 3,602 STEMI patients enrolled (18.5%) underwent PCI of culprit and nonculprit lesions for multivessel disease. Patients were categorized into a single PCI strategy (n = 275) versus staged PCI (n = 393). The endpoints analyzed included the 1-year rates of major adverse cardiovascular events and its components, death, reinfarction, target-vessel revascularization for ischemia, and stroke. RESULTS: Single versus staged PCI was associated with higher 1-year mortality (9.2% vs. 2.3%; hazard ratio [HR]: 4.1, 95% confidence interval [CI]: 1.93 to 8.86, p < 0.0001), cardiac mortality (6.2% vs. 2.0%; HR: 3.14, 95% CI: 1.35 to 7.27, p = 0.005), definite/probable stent thrombosis (5.7% vs. 2.3%; HR: 2.49, 95% CI: 1.09 to 5.70, p = 0.02), and a trend toward greater major adverse cardiovascular events (18.1% vs. 13.4%; HR: 1.42, 95% CI: 0.96 to 2.1, p = 0.08). The mortality advantage favoring staged PCI was maintained in a subgroup of patients undergoing truly elective multivessel PCI. Also, the staged PCI strategy was independently associated with lower all-cause mortality at 30 days and at 1 year. CONCLUSIONS: A deferred angioplasty strategy of nonculprit lesions should remain the standard approach in patients with STEMI undergoing primary PCI, as multivessel PCI may be associated with a greater hazard for mortality and stent thrombosis. (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction [HORIZONS-AMI]; NCT00433966). SN - 1558-3597 UR - https://www.unboundmedicine.com/medline/citation/21816305/Prognostic_impact_of_staged_versus_"one_time"_multivessel_percutaneous_intervention_in_acute_myocardial_infarction:_analysis_from_the_HORIZONS_AMI__harmonizing_outcomes_with_revascularization_and_stents_in_acute_myocardial_infarction__trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)01874-2 DB - PRIME DP - Unbound Medicine ER -