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Revascularization Strategies in Patients With STEMI: Culprit-Only vs Multivessel Revascularization Using Percutaneous
Noor Alsadat, Karice Hyun, Mario D'Souza
17 Concord Repatriation General Hospital, The University of Sydney, NSW, Australia. David.Brieger@health.nsw.gov.au.
Insights
Multivessel PCI for ST-elevation myocardial infarction (STEMI) with multivessel coronary disease (MVD) is more common in sicker patients and linked to worse in-hospital outcomes. Rates of multivessel versus culprit-only PCI remained stable from 2009-2015.
Area of Science:
- Cardiology
- Interventional Cardiology
- Public Health
Background:
- Approximately 50% of ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) have multivessel coronary disease (MVD).
- Conflicting evidence exists regarding the optimal PCI strategy for STEMI-MVD patients.
- This study analyzes Australian CONCORDANCE registry data to compare practices and outcomes of multivessel versus culprit-only PCI.
Purpose of the Study:
- To describe the practice patterns of multivessel versus culprit-only PCI in STEMI-MVD patients.
- To compare in-hospital and 6-month outcomes between patients receiving multivessel versus culprit-only PCI.
- To assess trends in the relative frequency of these PCI approaches over time.
Main Methods:
- Two cohorts were created from STEMI-MVD patients undergoing primary PCI (2009-2015): culprit-only PCI (n=587) and multivessel PCI (n=82).
- Clinical characteristics, in-hospital outcomes (mortality, heart failure, myocardial reinfarction), and 6-month follow-up outcomes were analyzed.
- The relative prevalence of each procedure was examined over the study period.
Main Results:
- Patient cohorts were similar in demographics and cardiovascular risk factors.
- Multivessel PCI was more frequent in patients with higher Killip scores and associated with increased in-hospital cardiogenic shock, myocardial reinfarction, cardiac arrest, and stroke.
- No significant difference in ischemic events at 6 months was observed, but multivessel PCI had fewer planned repeat revascularizations; procedural frequency remained stable.
Conclusions:
- The adoption of multivessel PCI for STEMI-MVD patients has not changed significantly between 2009 and 2015.
- Complete revascularization during the index procedure is more likely in severely ill patients and correlates with higher in-hospital complication rates.
- Further research is needed to clarify the optimal PCI strategy for STEMI-MVD patients.
Background:
Approximately 50% of patients undergoing primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) have multivessel coronary disease (MVD). Evidence on the best PCI approach for these patients is conflicting. The aim of this study is to examine Australian data from the CONCORDANCE registry to describe the practice and outcomes of patients receiving multivessel vs culprit-only PCI.
Methods:
Two cohorts were constructed from MVD-STEMI patients undergoing primary PCI at 41 hospitals between 2009 and 2015: culprit-only PCI (n = 587; 87%) and multivessel PCI (n = 82; 12%). Clinical characteristics were described, and the outcomes were all-cause mortality, heart failure, and myocardial reinfarction, in-hospital and at 6-month follow-up. The relative prevalence of each procedure over time was also described.
Results:
The patient cohorts were comparable in age, sex, and cardiovascular risk factors. Patients with higher Killip scores were more likely to receive multivessel PCI (P=.02). The multivessel group was significantly more likely to have in-hospital cardiogenic shock (P<.01), myocardial reinfarction (P=.02), cardiac arrest (P=.02), and stroke (P=.01). There was no difference in the incidence of ischemic events at 6 months, but the multivessel group had a lower rate of planned repeat revascularizations (12% vs 2%; P=.03). There was no difference in the relative frequency of multivessel vs culprit-only PCI during the observation period.
Conclusions:
The relative frequency of multivessel vs culprit-only PCI has not changed from 2009-2015. Index complete revascularization for STEMI-MVD patients is more likely to be performed in those with worse presentations and is associated with worse in-hospital complications.
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