Comparison of complete vs. culprit-only revascularization in acute myocardial infarction
1Department of Cardiology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China.
Insights
Complete revascularization for acute myocardial infarction with multivessel disease does not significantly reduce major adverse cardiovascular events compared to culprit-only intervention. However, complete revascularization may benefit hypertensive patients long-term.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Medicine
Background:
- Percutaneous coronary intervention (PCI) is standard for acute myocardial infarction (AMI) with multivessel disease (MVD).
- The benefit of PCI in non-infarct-related arteries for AMI with MVD remains debated.
- This study evaluates clinical outcomes of complete versus culprit-only revascularization before discharge.
Purpose of the Study:
- To compare the clinical outcomes of complete revascularization (CR) versus culprit-only revascularization (COR) in patients with AMI and MVD.
- To assess the incidence of major adverse cardiovascular and cerebral events (MACCE) at 1, 6, and 12 months post-PCI.
- To identify patient subgroups that may benefit from CR.
Main Methods:
- Retrospective analysis of 173 patients with AMI and MVD undergoing emergent PCI (January 2013 - December 2018).
- Patients were divided into CR (n=85) and COR (n=88) groups.
- MACCE, including recurrent angina, MI, in-stent thrombosis, AF, and HF, were compared at follow-up intervals.
Main Results:
- No significant difference in MACCE between COR and CR groups at 1, 6, or 12 months (36.2% vs. 33.3%, 42.0% vs. 29.7%, 44.9% vs. 36.5%, respectively).
- The COR group had a significantly higher rate of recurrent angina at 6 months (20.3% vs. 5.4%).
- Hypertensive patients showed improved outcomes with CR at 6 and 12 months.
Conclusions:
- Complete revascularization before discharge offers no significant long-term MACCE benefit over culprit-only intervention in AMI patients with MVD.
- Culprit-only revascularization may be associated with a higher rate of recurrent angina.
- Hypertension is a potential factor influencing the benefit of complete revascularization.
Background:
The diagnosis and treatment of acute myocardial infarction (AMI) complicated with multivessel disease (MVD) by percutaneous coronary intervention (PCI) has been well recognized. However, the use of PCI in non-infarct-related coronary arteries remains controversial. We aimed to study the clinical outcome of complete vs. culprit-only revascularization for AMI with MVD before discharge.
Methods:
173 AMI with MVD who received emergent PCI between January 2013 and December 2018 were retrospectively analyzed. Patients were divided into complete revascularization (CR) group (n = 85) and culprit-only revascularization (COR) group (n = 88). Major adverse cardiovascular and cerebral events (MACCE) at 1, 6, and 12 months after PCI were compared, including recurrent angina, recurrent MI, in-stent thrombosis, new-onset atrial fibrillation (AF), and worsen heart failure (HF).
Results:
Baseline characteristics of two groups were comparable. There was no significantly statistical difference in MACCE between COR group and CR group, 36.2% vs. 33.3% (P = 0.715), 42.0% vs. 29.7% (p = 0.125) and 44.9% vs. 36.5% (p = 0.304) at 1-, 6- and 12-month follow up respectively. Compared with the CR group, a higher rate of recurrent angina was in COR group (20.3% vs. 5.4%, P = 0.007) at the 6th month. Subgroup analysis showed that hypertensive patients benefited more from complete revascularization at the 6- (OR:0.31, 95%CI: 0.13-0.76) and 12-month (OR:0.38, 95%CI: 0.16-0.90) follow up.
Conclusions:
Complete revascularization before discharge does not supply additional benefit on long time MACCE as compared with culprit-only intervention strategy in patients presenting with AMI for urgent PCI with multivessel disease.
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