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Published on: April 25, 2014
Complete or incomplete revascularization in patients with left main culprit lesion acute myocardial infarction with
Sun Oh Kim1, Hong-Ju Kim1, Jong-Il Park1
1Division of Cardiology, Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea.
Insights
For acute myocardial infarction (AMI) involving the left main (LM) artery with multivessel disease, complete revascularization showed no significant clinical outcome benefit over incomplete revascularization at one year. This finding applies to patients undergoing percutaneous coronary intervention.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- Complete revascularization improves outcomes in acute myocardial infarction (AMI) with multivessel disease.
- Evidence is limited regarding the benefit of complete revascularization in left main (LM) culprit lesion AMI with multivessel disease.
Purpose of the Study:
- To compare the clinical outcomes of complete versus incomplete revascularization in patients with LM culprit lesion AMI and multivessel disease.
Main Methods:
- Retrospective review of 16,831 patients from the Korea Acute Myocardial Infarction Registry (July 2016-June 2020).
- 399 patients with LM culprit lesion AMI treated with percutaneous coronary intervention were analyzed.
- Propensity score matching (PSM) was used to compare outcomes between complete (n=295) and incomplete (n=104) revascularization groups.
- The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE) at 1 year.
Main Results:
- After PSM, no significant difference in MACCE at 1 year was observed between complete and incomplete revascularization groups (12.1% vs. 15.2%; p=0.524).
- Individual components of MACCE and rates of major bleeding were also similar between the groups.
Conclusions:
- Complete revascularization does not offer a significant clinical outcome advantage over incomplete revascularization in LM culprit lesion AMI with multivessel disease.
- Percutaneous coronary intervention strategies for this specific patient group require further investigation.
Background:
Complete revascularization has demonstrated better outcomes in patients with acute myocardial infarction (AMI) and multivessel disease. However, in the case of left main (LM) culprit lesion AMI with multivessel disease, there is limited evidence to suggest that complete revascularization is better.
Methods:
We reviewed 16,831 patients in the Korea Acute Myocardial Infarction Registry who were treated from July 2016 to June 2020, and 399 patients were enrolled with LM culprit lesion AMI treated with percutaneous coronary intervention. We categorized the patients as those treated with complete revascularization (n=295) or incomplete revascularization (n=104). The study endpoint was major adverse cardiac and cerebrovascular events (MACCE), a composite of all-cause death, myocardial infarction, ischemia-driven revascularization, stent thrombosis, and stroke. We performed propensity score matching (PSM) and analyzed the incidence of MACCE at 1 year.
Results:
After PSM, the two groups were well balanced. There was no significant difference between the two groups in MACCE at 1 year (12.1% vs. 15.2%; hazard ratio, 1.28; 95% confidence interval, 0.60-2.74; p=0.524) after PSM. The components of MACCE and major bleeding were also not significantly different.
Conclusion:
There was no significant difference in clinical outcomes between the groups treated with complete or incomplete revascularization for LM culprit lesion AMI with multivessel disease.
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