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[Results of primary angioplasty in patients with multivessel disease]
Insights
Multivessel disease in acute myocardial infarction patients undergoing primary angioplasty is an independent risk factor for mortality. This is due to increased complications, worse baseline profile, and higher revascularization needs, not just cardiogenic shock.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Research
Context:
- Acute myocardial infarction (AMI) patients treated with primary angioplasty often have multivessel disease.
- The independent prognostic impact of multivessel disease in AMI remains debated.
- Understanding factors contributing to worse outcomes in AMI with multivessel disease is crucial for treatment strategies.
Purpose:
- To determine if multivessel disease is an independent prognostic factor in AMI patients treated with primary angioplasty.
- To identify mechanisms contributing to the poorer prognosis in patients with multivessel disease.
- To analyze the association between multivessel disease and in-hospital outcomes.
Summary:
- A study of 312 AMI patients treated with primary angioplasty found that 51% had multivessel disease.
- Patients with multivessel disease were older, had more comorbidities (diabetes, hypertension), and presented with higher Killip class.
- Multivessel disease was independently associated with higher in-hospital mortality, increased need for revascularization, and higher incidence of complications like severe mitral regurgitation and atrioventricular blockade.
Impact:
- Multivessel disease is an independent predictor of mortality in AMI patients undergoing primary angioplasty.
- The worse prognosis is multifactorial, including baseline patient profile, complication rates, and revascularization requirements.
- Findings emphasize the importance of considering multivessel disease extent in risk stratification and management of AMI.
Introduction:
In patients with acute myocardial infarction treated with primary angioplasty, multivessel disease is associated with a higher mortality. However, if higher mortality is simply due to a higher prevalence of cardiogenic shock or if multivessel disease is an independent risk factor remains unclear.
Objectives:
To study if multivessel disease constitute an independent prognostic factor in patients with acute myocardial infarction treated with primary angioplasty, and to ascertain possible mechanisms contributing to the worse prognosis found in these patients.
Patients And Methods:
Between august 1991 and october 1996, 312 patients with acute myocardial infarction were treated with primary angioplasty in our center. Characteristics and in-hospital outcome of patients with or without multivessel disease were compared.
Results:
Patients with multivessel disease (n = 158; 51%) were older (64 +/- 11 vs 61 +/- 13 years; p = 0.017), less often smokers (60% vs. 76%; p = 0.006) and had a higher prevalence of diabetes (35% vs. 20%; p = 0.007), hypertension (54% vs. 39%; p = 0.012), prior acute myocardial infarction (29% vs. 5%; p < 0.001), prior coronary bypass (2% vs. 0%; p = 0.042) and Killip class IV at admission (19% vs. 8%; p < 0.001). Angiographic success rate was not different in patients with or without multivessel disease (89% vs. 92%; NS). Patients with multivessel disease had a higher in-hospital mortality (21% vs. 7%; p < 0.001), need of revascularization (17% vs. 3%; p < 0.001) and incidence of severe mitral regurgitation, (5% vs. 0%; p < 0.001), second or third atrioventricular blockade (10% vs. 1%; p < 0.001) and severe bleeding (4% vs. 1%; p = 0.089). After excluding patients with Killip class III or IV at admission, mortality was also higher in patients with multivessel disease (9% vs. 2%; p = 0.009). Multivariate analysis showed the following independent risk factors for mortality: age > 65 years, Killip class IV and multivessel disease.
Conclusions:
In patients with acute myocardial infarction treated with primary angioplasty, multivessel disease is associated with higher mortality. This is due not only to a higher prevalence of cardiogenic shock at admission, but also to a worse baseline profile, a higher incidence of complications and a more frequent need of revascularization.