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Multivessel vs culprit-only percutaneous coronary intervention among patients 65 years or older with acute myocardial

Tracy Y Wang1, Lisa A McCoy1, Deepak L Bhatt2

  • 1Duke Clinical Research Institute, Durham, NC.

American Heart Journal
|February 10, 2016
PubMed

Insights

Multivessel intervention during percutaneous coronary intervention (PCI) for older adults with ST-segment elevation myocardial infarction (STEMI) was linked to higher mortality. However, no significant differences in outcomes were found for non-ST-elevation myocardial infarction (NSTEMI) patients.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Geriatric Medicine

Background:

  • Older adults with acute myocardial infarction (MI) often have multivessel coronary artery disease.
  • Percutaneous coronary intervention (PCI) is a common treatment, but risks of multivessel intervention in this population need evaluation.

Purpose of the Study:

  • To determine if nonculprit intervention during PCI is associated with better outcomes in older patients with acute MI and multivessel disease.

Main Methods:

  • Examined 19,271 STEMI and 31,361 NSTEMI patients (≥65 years) with multivessel disease using a linked registry-Medicare database.
  • Used inverse probability-weighted propensity adjustment to compare mortality between culprit-only versus multivessel intervention during index PCI.

Main Results:

  • Most older MI patients received culprit-only intervention (91% STEMI, 74% NSTEMI).
  • Multivessel intervention in STEMI patients was associated with higher 30-day mortality (8.3% vs 6.3%) and a trend persisted at 1 year.
  • No significant mortality differences were observed for NSTEMI patients at 30 days or 1 year.

Conclusions:

  • Nonculprit intervention during index PCI was associated with worse outcomes in older STEMI patients.
  • No significant mortality differences were observed for older NSTEMI patients treated with multivessel intervention.
Abstract

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