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Culprit vessel percutaneous coronary intervention versus multivessel and staged percutaneous coronary intervention
Edward L Hannan1, Zaza Samadashvili, Gary Walford
1School of Public Health, University at Albany, State University of New York, Albany, New York 12144-3456, USA. elh03@health.state.ny.us
Insights
For ST-segment elevation myocardial infarction (STEMI) patients with multivessel disease, culprit vessel percutaneous coronary interventions (PCI) during the index procedure is linked to lower in-hospital mortality. Staged PCI within 60 days offers comparable long-term survival.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- Optimal treatment for ST-segment elevation myocardial infarction (STEMI) with multivessel disease remains a key area of research, especially with advancements in drug-eluting stents.
- Understanding the comparative effectiveness of different percutaneous coronary intervention (PCI) strategies is crucial for patient management.
Purpose of the Study:
- To compare in-hospital and longer-term mortality rates for STEMI patients with multivessel disease based on whether they received single-vessel (culprit vessel) PCI or multivessel PCI.
- To evaluate the impact of PCI timing and extent on patient outcomes in this specific population.
Main Methods:
- A retrospective analysis of STEMI patients with multivessel disease undergoing PCI in New York (2003-2006).
- Patients were categorized into culprit vessel PCI or multivessel PCI groups (index procedure, index admission, or staged within 60 days).
- Propensity matching was used to compare mortality rates at 12, 24, and 42 months.
Main Results:
- Culprit vessel PCI during the index procedure was associated with lower in-hospital mortality in hemodynamically stable patients (0.9% vs. 2.4%, p=0.04).
- Staged multivessel PCI within 60 days showed significantly lower 12-month mortality compared to culprit vessel PCI alone (1.3% vs. 3.3%, p=0.04).
Conclusions:
- Findings support current guidelines recommending culprit vessel PCI for hemodynamically stable STEMI patients with multivessel disease during the initial procedure.
- Staged PCI within 60 days, including during the index admission, demonstrates risk-adjusted mortality comparable to culprit vessel PCI alone.
Objectives:
The purpose of this study was to examine the differences in in-hospital and longer-term mortality for ST-segment elevation myocardial infarction (STEMI) patients with multivessel disease as a function of whether they underwent single-vessel (culprit vessel) percutaneous coronary interventions (PCIs) or multivessel PCI.
Background:
The optimal treatment of patients with STEMI and multivessel disease is of continuing interest in the era of drug-eluting stents.
Methods:
STEMI patients with multivessel disease undergoing PCIs in New York between January 1, 2003, and June 30, 2006, were subdivided into those who underwent culprit vessel PCI and those who underwent multivessel PCI during the index procedure, during the index admission, or staged within 60 days of the index admission. Patients were propensity-matched and mortality rates were calculated at 12, 24, and 42 months.
Results:
A total of 3,521 patients (87.5%) underwent culprit vessel PCI during the index procedure. A total of 259 of them underwent staged PCI during the index admission and 538 patients underwent staged PCI within 60 days of the index procedure. For patients without hemodynamic compromise, culprit vessel PCI during the index procedure was associated with lower in-hospital mortality than multivessel PCI during the index procedure (0.9% vs. 2.4%, p = 0.04). Patients undergoing staged multivessel PCI within 60 days after the index procedure had a significantly lower 12-month mortality rate than patients undergoing culprit vessel PCI only (1.3% vs. 3.3%, p = 0.04).
Conclusions:
Our findings support the American College of Cardiology/American Heart Association (ACC/AHA) recommendation that culprit vessel PCI be used for STEMI patients with multivessel disease at the time of the index PCI when patients are not hemodynamically compromised. However, staged PCI within 60 days after the index procedure, including during the index admission, is associated with risk-adjusted mortality rates that are comparable with the rate for culprit vessel PCI alone.
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