Influence of multivessel disease with or without additional revascularization on mortality in patients with
Lisette Okkels Jensen1, Christian Juhl Terkelsen2, Erzsébet Horváth-Puhó3
1Department of Cardiology, Odense University Hospital, Odense, Denmark.
Insights
Patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease have higher mortality. Additional revascularization improves survival in these patients compared to culprit vessel PCI only.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes
Background:
- ST-segment elevation myocardial infarction (STEMI) requires timely reperfusion via primary percutaneous coronary intervention (PCI).
- Optimal PCI strategy for STEMI patients with multivessel disease remains debated.
- This study investigates mortality differences based on vessel disease extent and revascularization extent.
Purpose of the Study:
- To compare mortality in STEMI patients with single-vessel disease versus multivessel disease.
- To evaluate the impact of additional revascularization of nonculprit lesions on mortality in STEMI patients with multivessel disease.
Main Methods:
- Retrospective analysis of 8,822 STEMI patients treated with primary PCI from the Western Denmark Heart Registry (2002-2009).
- Cox regression models were used to estimate hazard ratios for death, controlling for confounders.
- Patients were categorized into single-vessel disease and multivessel disease groups, with further stratification for multivessel disease based on additional revascularization.
Main Results:
- Multivessel disease was associated with significantly higher 7-year mortality compared to single-vessel disease (adjusted HR 1.45).
- Among multivessel disease patients, those without additional revascularization had higher 7-year mortality than those with it (adjusted HR 1.50).
- Seven-year mortality was similar between multivessel disease patients who received additional revascularization and single-vessel disease patients (adjusted HR 1.01).
Conclusions:
- Multivessel disease in STEMI patients is linked to increased mortality.
- Additional revascularization in STEMI patients with multivessel disease improves survival outcomes.
- PCI strategy should consider the extent of coronary artery disease for optimal patient survival.
Background:
In patients with ST-segment elevation myocardial infarction (STEMI), timely reperfusion with primary percutaneous coronary intervention (PCI) is the preferred treatment. In primary PCI patients with multivessel disease, it is unclear whether culprit vessel PCI only is the preferred treatment. We compared mortality among (1) STEMI patients with single-vessel disease and those with multivessel disease and (2) multivessel disease patients with and without additional revascularization of nonculprit lesions within 2 months after the index PCI.
Methods:
From January 2002 to June 2009, all patients presenting with STEMI and treated with primary PCI were identified from the Western Denmark Heart Registry, which covers a population of 3.0 million. The hazard ratio (HR) for death was estimated using a Cox regression model, controlling for potential confounding.
Results:
The study cohort consisted of 8,822 patients: 4,770 (54.1%) had single-vessel disease and 4,052 (45.9%) had multivessel disease. Overall, 1-year cumulative mortality was 7.6%, and 7-year cumulative mortality was 24.0%. Multivessel disease was associated with higher 7-year mortality (adjusted HR 1.45 [95% CI 1.30-1.62], P < .001). Among patients with multivessel disease, lack of additional revascularization beyond the culprit lesion was associated with higher 7-year mortality (adjusted HR 1.50 [95% CI 1.25-1.80], P < .001). In patients with multivessel disease who underwent additional revascularization, 7-year mortality (adjusted HR 1.01 [95% CI 0.84-1.22], P = .89) was similar compared to patients with single-vessel disease.
Conclusion:
In STEMI patients, multivessel disease was associated with a higher mortality compared to single-vessel disease. In multivessel disease patients, additional revascularization was associated with a higher survival compared with culprit vessel PCI only.
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