Multivessel percutaneous coronary intervention in patients with stable angina: a common approach? Lessons learned
Timm Bauer1, Helge Möllmann, Uwe Zeymer
1Herzzentrum Ludwigshafen, Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg, Heidelberg, Germany. Bauer-Timm@gmx.de
Insights
Multivessel percutaneous coronary intervention (MV-PCI) in Europe showed low hospital mortality. While complications were minimal, patients undergoing MV-PCI had a trend toward higher rates of postprocedural myocardial infarction compared to single-vessel PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Public Health
Background:
- Coronary artery disease (CAD) affects millions globally, necessitating effective revascularization strategies.
- Percutaneous coronary intervention (PCI) is a primary treatment for CAD, with decisions often involving single-vessel versus multivessel approaches.
Purpose of the Study:
- To evaluate clinical characteristics, procedural details, and outcomes of patients undergoing elective multivessel percutaneous coronary intervention (MV-PCI) in Europe.
- To compare outcomes of MV-PCI with single-vessel PCI (SV-PCI) in a large European cohort.
Main Methods:
- Analysis of 7113 patients with stable CAD from the Euro Heart Survey PCI registry.
- Comparison of patients undergoing MV-PCI (n=3376) versus SV-PCI (n=3737).
- Multivariate analysis to identify predictors and assess outcomes, including hospital mortality and postprocedural myocardial infarction.
Main Results:
- Nearly half of European patients with multivessel disease underwent MV-PCI.
- Patients undergoing MV-PCI were more likely to have congestive heart failure.
- Hospital mortality was low in both groups (0.1% vs 0.3%); however, MV-PCI showed a trend towards higher postprocedural myocardial infarction rates (OR 1.57, 95% CI 0.93-2.67).
Conclusions:
- Elective MV-PCI is frequently performed in Europe for multivessel coronary artery disease.
- While hospital outcomes are generally favorable, careful consideration of the potential increased risk of postprocedural myocardial infarction is warranted for MV-PCI.
- Age, comorbidities, and coronary anatomy are key determinants for selecting MV-PCI.
Abstract:
The aim of this study was to evaluate clinical characteristics, procedural details, and outcomes of patients undergoing elective multivessel percutaneous coronary intervention (MV-PCI) in Europe. A total of 7113 patients with stable coronary artery disease and at least two major epicardial vessels with ≥ 70% stenosis were included in this analysis of the contemporary Euro Heart Survey PCI registry. Patients undergoing MV-PCI (n = 3376, 47.5%) were compared with those with single-vessel PCI (SV-PCI) (n = 3737, 52.5%). Patients with MV-PCI were more likely to have congestive heart failure, whereas those with SV-PCI more often suffered from noncardiac comorbidities. Hospital mortality (0.1% vs 0.3%) and the incidence of nonfatal postprocedural myocardial infarction (1.0% vs 0.7%) were low in patients with MV-PCI and SV-PCI. In the multivariate analysis, no significant difference in the incidence of hospital death (odds ratio (OR) 0.44, 95% confidence interval (CI) 0.15-1.27) could be observed between the two groups. However, the risk for postprocedural myocardial infarction (OR 1.57, 95% CI 0.93-2.67) tended to be higher among patients undergoing MV-PCI. Independent determinants for performing MV-PCI were age, comorbidities, and coronary anatomy. In Europe almost half of all patients with multivessel disease were treated with MV-PCI. Hospital complications were low, but a trend toward a higher rate of postprocedural myocardial infarctions was seen in patients with MV-PCI.
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