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A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
18:11

A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis

Published on: December 28, 2012

Culprit only or multivessel percutaneous coronary interventions in patients with ST-segment elevation myocardial

Lisette Okkels Jensen1, Per Thayssen, Dóra Körmendiné Farkas

  • 1Department of Cardiology, Odense University Hospital, Denmark. okkels@dadlnet.dk

Eurointervention : Journal of Europcr in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
|August 25, 2012
PubMed

Insights

For ST-elevation myocardial infarction (STEMI) patients, acute multivessel percutaneous coronary intervention (PCI) increases mortality risk. Staged PCI within 60 days is associated with significantly lower one-year mortality compared to single-vessel intervention.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Clinical Research

Background:

  • ST-segment elevation myocardial infarction (STEMI) requires prompt reperfusion, typically via primary percutaneous coronary intervention (PPCI).
  • The optimal revascularization strategy in STEMI patients with multivessel disease remains debated: complete revascularization versus culprit-only lesion intervention.

Purpose of the Study:

  • To compare one-year mortality rates following different timing strategies for multivessel percutaneous coronary intervention (PCI) in STEMI patients.
  • To evaluate the safety and efficacy of acute, in-hospital staged, and delayed staged multivessel PCI compared to single-vessel PCI.

Main Methods:

  • Retrospective analysis of 5,944 STEMI patients treated with PPCI from January 2002 to June 2009, identified from the Western Denmark Heart Registry.
  • Patients were categorized based on the timing of multivessel PCI: acute (during index hospitalization), staged (within index hospitalization), or staged (within 60 days post-index hospitalization).
  • Time-dependent Cox regression models were used to estimate hazard ratios (HR) for one-year all-cause mortality.

Main Results:

  • Of 5,944 patients, 1,174 (20%) underwent multivessel PCI within 60 days.
  • Compared to single-vessel PCI, acute multivessel PCI (n=354) showed an increased one-year mortality HR of 1.53 (95% CI: 1.07-2.18).
  • Staged multivessel PCI within 60 days (n=626) demonstrated a significantly reduced one-year mortality HR of 0.28 (95% CI: 0.14-0.54).

Conclusions:

  • Acute multivessel PCI during the index hospitalization for STEMI is associated with higher mortality.
  • A staged multivessel PCI strategy, particularly within 60 days, appears safer and is linked to reduced long-term mortality in STEMI patients.
  • These findings suggest that a delayed, staged approach to multivessel revascularization may be optimal for STEMI patients.
Abstract

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