Revascularization Strategies in Patients Presenting With ST-Elevation Myocardial Infarction and Multivessel Coronary Disease
| Autor: | Laurens J.C. van Zandvoort, Isabella Kardys, Kaneshka Masdjedi, Roberto Diletti, Jeroen Wilschut, Nicolas M. Van Mieghem, Miguel E. Lemmert, Koen Ameloot, Paola Scarparo, Maria Natalia Tovar Forero, Joost Daemen, Peter de Jaegere, Wijnand K den Dekker, Felix Zijlstra, Matthew M Balbi |
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| Přispěvatelé: | Cardiology |
| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Coronary Artery Disease 030204 cardiovascular system & hematology Revascularization Culprit 03 medical and health sciences 0302 clinical medicine Internal medicine Myocardial Revascularization medicine Humans cardiovascular diseases 030212 general & internal medicine Myocardial infarction Survival rate Aged business.industry Percutaneous coronary intervention Stent Middle Aged medicine.disease Survival Rate medicine.anatomical_structure Cardiology ST Elevation Myocardial Infarction Female Cardiology and Cardiovascular Medicine business Mace Artery |
| Zdroj: | American Journal of Cardiology, 125(10), 1486-1491. Elsevier Inc. |
| ISSN: | 0002-9149 |
| DOI: | 10.1016/j.amjcard.2020.01.050 |
| Popis: | The optimal revascularization strategy for residual coronary stenosis following primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease (MVD) remains controversial. This is a retrospective single-centre study including patients with STEMI and MVD. Based on the revascularization strategy, 3 groups were identified: (1) culprit only (CO), (2) ad hoc multivessel revascularization (MVR), and (3) staged MVR. Clinical outcomes were compared in terms of major adverse cardiac events (MACE), a composite of cardiac death, any myocardial infarction, and any unplanned revascularization at a long-term follow-up. A total of 958 patients were evaluated, 489 in the CO, 254 in the ad hoc, and 215 in the staged group. In the staged group, 65.6% of the patients received planned percutaneous coronary intervention, 9.7% coronary artery bypass grafting, 8.4% no further intervention after lesion reassessment, and in 16.3% an event occurred before the planned procedure. At 1,095 days, MACE was 36.1%, 16.7%, and 31% for CO, ad hoc, and staged groups, respectively. A MVR strategy was associated with lower rate of all-cause death compared with CO (HR 0.50; 95%CI [0.31 to 0.80]; p = 0.004). Complete revascularization reduced the rate of MACE (HR 0.30 [0.21 to 0.43] p < 0.001) compared with incomplete revascularization. Ad hoc MVR had lower rate of MACE compared with staged MVR (HR 0.61 [0.39 to 0.96] p = 0.032) mainly driven by less unplanned revascularizations. In conclusion, in patients with STEMI and MVD, complete revascularization reduced the risk of MACE. Ad hoc MVR appeared a reasonable strategy with lower contrast and stent usage and costs. |
| Databáze: | OpenAIRE |
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