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Published on: February 16, 2011
Multivessel percutaneous coronary intervention in patients with acute myocardial infarction and severe renal
Pil Sang Song1, Joo-Yong Hahn, Hyeon-Cheol Gwon
1Division of Cardiology, Heart Stroke Vascular Center, Mediplex Sejong General Hospital, Incheon, Republic of Korea.
Insights
Multivessel PCI and infarct-related artery-only PCI showed similar outcomes for acute myocardial infarction patients with multivessel disease and severe renal dysfunction. However, multivessel PCI trended towards worsening renal function.
Area of Science:
- Cardiology
- Nephrology
- Interventional Cardiology
Background:
- Acute myocardial infarction (AMI) with multivessel disease (MVD) and severe renal dysfunction (RD) presents complex treatment challenges.
- Optimal revascularization strategy in this high-risk population remains debated.
Purpose of the Study:
- To compare clinical outcomes of multivessel percutaneous coronary intervention (PCI) versus infarct-related artery (IRA)-only PCI.
- To evaluate safety, specifically worsening renal function (WRF), in patients with AMI, MVD, and severe RD.
Main Methods:
- Analysis of a nationwide AMI registry including 537 patients with severe RD (eGFR <30 mL/min/1.73 m2).
- Patients were stratified into multivessel PCI (49.0%) or IRA-only PCI groups.
- Primary endpoint: major adverse cardiac events (MACE) at one year. Safety endpoint: WRF at 12-month follow-up.
Main Results:
- Adjusted MACE risks were similar between multivessel PCI and IRA-only PCI groups (HR 1.008 and 0.974 in Cox regression and propensity score-matching, respectively).
- Multivessel PCI demonstrated a trend towards higher rates of WRF (24.8% vs 11.1%, aOR 2.134).
Conclusions:
- Multivessel PCI is associated with similar one-year MACE compared to IRA-only PCI in patients with AMI, MVD, and severe RD.
- A potential increased risk of worsening renal function warrants consideration with multivessel PCI in this cohort.
Aims:
The aim of this study was to compare the outcomes between multivessel and infarct-related artery (IRA)-only percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI), multivessel disease (MVD), and severe renal dysfunction (RD) using the nationwide AMI registry.
Methods And Results:
Among 13,104 patients, 537 diagnosed with AMI and MVD who had severe RD at presentation (estimated glomerular filtration rate [GFR] <30 mL/min/1.73 m2, mean: 19.1±7.5 mL/min/1.73 m2) and underwent PCI during index hospitalisation were selected. The patients were classified according to treatment strategy, i.e., multivessel PCI (49.0%) or IRA-only PCI. The primary endpoint was major adverse cardiac events (MACE), a composite of all-cause death, myocardial reinfarction, re-hospitalisation for heart failure, and any repeat revascularisation at one year. The safety outcome was the worsening of renal function (WRF), defined as a 30% reduction in estimated GFR from baseline to 12-month follow-up. The adjusted MACE risks were similar in groups after Cox regression (41.8% vs 39.8%, hazard ratio [HR] 1.008 [0.743-1.367]) and propensity score-matching analysis (HR 0.974 [0.651-1.377]). Multivessel PCI showed a significant tendency of higher rates of WRF (24.8% vs 11.1%, adjusted odds ratio 2.134 [0.976-4.668]).
Conclusions:
Multivessel PCI was associated with similar outcomes compared to IRA-only PCI in patients with AMI, MVD, and severe RD.
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