Multivessel approach in ST-elevation myocardial infarction: impact on in-hospital morbidity and mortality
Ana Rita Santos1, Bruno Cordeiro Piçarra1, Margarida Celeiro1
1Serviço de Cardiologia, Hospital do Espírito Santo, Évora, Portugal.
Insights
In ST-elevation myocardial infarction (STEMI) patients with multivessel disease, a multivessel approach during primary percutaneous coronary intervention (PCI) showed no increase in in-hospital mortality or complications, suggesting it is safe.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes
Background:
- Multivessel disease in ST-elevation myocardial infarction (STEMI) is linked to poorer patient outcomes.
- The optimal treatment strategy, specifically a multivessel approach during primary percutaneous coronary intervention (PCI), remains debated.
Purpose of the Study:
- To evaluate the impact of a multivessel PCI strategy on in-hospital mortality and morbidity in STEMI patients with multivessel disease.
Main Methods:
- A retrospective analysis of 257 STEMI patients with multivessel disease undergoing primary PCI from the Portuguese Registry of Acute Coronary Syndromes.
- Patients were categorized into two groups: culprit-only PCI and multivessel PCI.
- Data collected included cardiovascular risk factors, STEMI characteristics, treatments, stent types, and ejection fraction. Primary endpoint was in-hospital mortality; secondary endpoints included major bleeding, transfusion, ventilation, heart failure, and reinfarction.
Main Results:
- Multivessel disease was present in 43.3% of STEMI patients; 19.2% received a multivessel PCI approach.
- No significant differences were observed in cardiovascular risk factors or STEMI presentation between groups.
- Patients undergoing multivessel PCI were more likely to receive drug-eluting stents and glycoprotein IIb/IIIa inhibitors, and less likely to receive heparin.
Conclusions:
- In this cohort of STEMI patients with multivessel disease, a multivessel PCI approach was found to be safe.
- The multivessel strategy was not associated with an increased risk of in-hospital mortality or major complications.
Introduction:
Multivessel disease in ST-elevation myocardial infarction (STEMI) is associated with a worse prognosis. A multivessel approach at the time of primary percutaneous coronary intervention (PCI) is the subject of debate.
Objective:
To assess the impact of a multivessel approach on in-hospital morbidity and mortality in patients with STEMI undergoing primary PCI.
Methods:
We studied patients from the Portuguese Registry of Acute Coronary Syndromes with STEMI and multivessel disease who underwent primary PCI. The 257 patients were divided into two groups: those who underwent PCI of the culprit artery only and those who underwent multivessel PCI. Cardiovascular risk factors, STEMI location, in-hospital treatment, number and type of diseased and treated arteries, type of stent implanted and ejection fraction were recorded. The primary end-point was defined as in-hospital mortality and the secondary end-point as the presence of at least one of the following complications: major bleeding, need for transfusion, invasive ventilation, heart failure and reinfarction.
Results:
Multivessel disease was found in 43.3% of the study population and a multivessel approach was adopted in 19.2% of these patients. There were no differences between the groups in cardiovascular risk factors or electrocardiographic presentation of STEMI. Patients undergoing multivessel PCI were more likely to be treated with drug-eluting stents and glycoprotein IIb/IIIa inhibitors, and less likely to receive heparin therapy. There were no differences between the groups with regard to in-hospital mortality or the incidence of complications.
Conclusion:
In our population of patients with STEMI, a multivessel approach appears to be safe and not associated with increased in-hospital mortality or morbidity.
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