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Clinical Outcomes of Complete Revascularization in Acute Myocardial Infarction Patients With High Bleeding Risk and
Onyou Kim1,2, Hyun Sung Joh3, Hyun Kuk Kim4
1Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea.
Insights
Complete revascularization (CR) in patients with acute myocardial infarction and multivessel disease significantly lowers adverse events, even in those with high bleeding risk (HBR). CR offers improved outcomes without increasing bleeding complications for HBR patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Research
Background:
- High bleeding risk (HBR) in acute myocardial infarction (AMI) patients correlates with worse prognosis.
- Limited data exists on the impact of complete revascularization (CR) in AMI patients with multivessel disease and HBR.
Purpose of the Study:
- To evaluate the prognostic impact of CR in AMI patients with multivessel disease, specifically comparing outcomes between those with and without HBR.
- To assess the association of CR with major adverse cardiac and cerebrovascular events (MACCE) and bleeding events in these patient groups.
Main Methods:
- Analysis of 13,460 patients with AMI and multivessel disease from a Korean registry (2011-2020).
- Patients underwent successful percutaneous coronary intervention for the infarct-related artery.
- Primary outcome was MACCE over 3-year follow-up; HBR classification used modified Academic Research Consortium-HBR criteria.
Main Results:
- 32.7% of patients had HBR; 35.8% underwent CR.
- HBR patients had significantly higher MACCE (35.7% vs. 16.4%) and bleeding risk (10.4% vs. 4.5%) compared to non-HBR.
- CR was associated with lower MACCE in both HBR (28.1% vs. 40.0%) and non-HBR (13.1% vs. 19.0%) groups, with similar bleeding event rates between CR and incomplete revascularization.
Conclusions:
- CR improves outcomes by reducing MACCE in AMI patients with multivessel disease, irrespective of bleeding risk.
- CR is a safe and effective strategy for both HBR and non-HBR patients, demonstrating comparable bleeding event rates.
Background:
High bleeding risk (HBR) is associated with an increased risk of both ischemic and bleeding events and is known to have a worse prognosis than non-HBR in patients with acute myocardial infarction. However, data regarding the prognostic impact of complete revascularization (CR) in acute myocardial infarction and multivessel disease patients complicated by HBR remain limited.
Methods:
A total of 13 460 patients with acute myocardial infarction and multivessel disease who underwent successful percutaneous coronary intervention for infarct-related artery were selected from the nationwide Korean registry from 2011 to 2020. Primary outcome was major adverse cardiac and cerebrovascular events during 3 years of follow-up.
Results:
Of the 13 460 patients, 4401 (32.7%) were classified as the group with HBR according to modified Academic Research Consortium-HBR criteria and 1577 patients (35.8%) underwent CR. Among the group without HBR, 3911 patients (43.2%) underwent CR for noninfarct-related artery. The group with HBR had significantly higher risk of major adverse cardiac and cerebrovascular events (non-HBR versus HBR; 16.4% versus 35.7%; adjusted hazard ratio [HR], 1.70 [95% CI, 1.56-1.85]; P<0.001) and Bleeding Academic Research Consortium type 2 or greater bleeding (4.5% versus 10.4%; adjusted HR, 1.63 [95% CI, 1.38-1.94]; P<0.001) than the group without HBR. Patients who underwent CR were associated with lower risk of major adverse cardiac and cerebrovascular events at 3 years than those with incomplete revascularization in both groups with HBR (40.0% versus 28.1%, adjusted HR, 0.65 [95% CI, 0.55-0.75], P<0.001) and without HBR (19.0% versus 13.1%, adjusted HR, 0.71 [95% CI, 0.63-0.80], P<0.001). The incidence of bleeding events was similar between the CR and incomplete revascularization groups in both groups with HBR (10.7% versus 10.0%, adjusted HR, 1.07 [95% CI, 0.84-1.37], P=0.572) and without HBR (4.2% versus 5.0%, adjusted HR, 0.98 [95% CI, 0.78-1.23], P=0.867).
Conclusions:
In patients with acute myocardial infarction and multivessel disease, CR was associated with a lower risk of major adverse cardiac and cerebrovascular events compared with incomplete revascularization in both HBR and non-HBR.
Registration:
KAMIR-NIH; KCT-0000863, KAMIR-V; KCT-0008355.
