Document Detail


Culprit vessel percutaneous coronary intervention versus multivessel and staged percutaneous coronary intervention for ST-segment elevation myocardial infarction patients with multivessel disease.
MedLine Citation:
PMID:  20129564     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: The purpose of this study was to examine the differences in in-hospital and longer-term mortality for ST-segment elevation myocardial infarction (STEMI) patients with multivessel disease as a function of whether they underwent single-vessel (culprit vessel) percutaneous coronary interventions (PCIs) or multivessel PCI.
BACKGROUND: The optimal treatment of patients with STEMI and multivessel disease is of continuing interest in the era of drug-eluting stents.
METHODS: STEMI patients with multivessel disease undergoing PCIs in New York between January 1, 2003, and June 30, 2006, were subdivided into those who underwent culprit vessel PCI and those who underwent multivessel PCI during the index procedure, during the index admission, or staged within 60 days of the index admission. Patients were propensity-matched and mortality rates were calculated at 12, 24, and 42 months.
RESULTS: A total of 3,521 patients (87.5%) underwent culprit vessel PCI during the index procedure. A total of 259 of them underwent staged PCI during the index admission and 538 patients underwent staged PCI within 60 days of the index procedure. For patients without hemodynamic compromise, culprit vessel PCI during the index procedure was associated with lower in-hospital mortality than multivessel PCI during the index procedure (0.9% vs. 2.4%, p = 0.04). Patients undergoing staged multivessel PCI within 60 days after the index procedure had a significantly lower 12-month mortality rate than patients undergoing culprit vessel PCI only (1.3% vs. 3.3%, p = 0.04).
CONCLUSIONS: Our findings support the American College of Cardiology/American Heart Association (ACC/AHA) recommendation that culprit vessel PCI be used for STEMI patients with multivessel disease at the time of the index PCI when patients are not hemodynamically compromised. However, staged PCI within 60 days after the index procedure, including during the index admission, is associated with risk-adjusted mortality rates that are comparable with the rate for culprit vessel PCI alone.
Authors:
Edward L Hannan; Zaza Samadashvili; Gary Walford; David R Holmes; Alice K Jacobs; Nicholas J Stamato; Ferdinand J Venditti; Samin Sharma; Spencer B King
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study    
Journal Detail:
Title:  JACC. Cardiovascular interventions     Volume:  3     ISSN:  1876-7605     ISO Abbreviation:  JACC Cardiovasc Interv     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2010-02-04     Completed Date:  2010-04-28     Revised Date:  2012-08-29    
Medline Journal Info:
Nlm Unique ID:  101467004     Medline TA:  JACC Cardiovasc Interv     Country:  United States    
Other Details:
Languages:  eng     Pagination:  22-31     Citation Subset:  IM    
Copyright Information:
Copyright (c) 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Affiliation:
School of Public Health, University at Albany, State University of New York, Albany, New York 12144-3456, USA. elh03@health.state.ny.us
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Angioplasty, Balloon, Coronary / adverse effects,  methods*,  mortality*
Coronary Artery Disease / complications,  mortality*,  physiopathology,  therapy*
Female
Hemodynamics
Hospital Mortality
Humans
Male
Middle Aged
Myocardial Infarction / etiology,  mortality*,  physiopathology,  therapy*
New York / epidemiology
Patient Selection
Practice Guidelines as Topic
Propensity Score
Registries
Risk Assessment
Risk Factors
Severity of Illness Index
Time Factors
Treatment Outcome
Comments/Corrections
Comment In:
JACC Cardiovasc Interv. 2010 Jan;3(1):32-4   [PMID:  20129565 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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