Management and outcomes of significant non-culprit coronary artery lesions in STEMI: a retrospective cohort study
| Autor: | Robert Erich Michael Weitemeyer, Ailish Hannigan, A. Ajani, T Kiernan, Yousif Abusalma, Hatim Yagoub, Shane Peter Murphy, Bryan P. Yan, C Ahern, Ruth Gillen |
|---|---|
| Rok vydání: | 2015 |
| Předmět: |
lcsh:Diseases of the circulatory (Cardiovascular) system
medicine.medical_specialty medicine.medical_treatment lcsh:Medicine Revascularization Culprit multivessel disease STEMI Median follow-up Internal medicine medicine cardiovascular diseases Myocardial infarction business.industry percutaneous coronary intervention lcsh:R Retrospective cohort study medicine.disease non-culprit lesions Surgery surgical procedures operative ST-elevation myocardial infarction lcsh:RC666-701 Conventional PCI Cohort business Mace |
| Zdroj: | International Cardiovascular Forum Journal, Vol 3, Pp 14-19 (2015) |
| ISSN: | 2409-3424 2410-2636 |
| DOI: | 10.17987/icfj.v3i0.113 |
| Popis: | BACKGROUND In the setting of ST-elevation myocardial infarction (STEMI) and multi-vessel disease (MVD), guidelines recommend revascularization of the culprit lesion (CL) only, due to poor evidence supporting intervention in non-culprit lesions (non-CLs) during the same index procedure. Debate over management for significant non-CLs is of interest i.e. medical management vs. percutaneous revascularization. We describe a cohort of patients with STEMI and MVD and compare the occurrence of major adverse cardiac events (MACE) by therapeutic strategies for non-CLs with regard to follow-up outcomes.METHODS 86 patients with STEMI and MVD were identified from a database of STEMI presentations to the University Hospital Limerick from Jan 2011 to April 2013. The occurrence of MACE was established by follow up with patients’ general practitioners.RESULTS 48% of presentations had MVD. Predominant management for non-CLs was medical therapy alone comprising 58% (n=50) of patients, while 23% (n=20) of patients underwent PCI for non-CL, and 19% (n=16) had CABG.Median follow up was 1.8 years (range 9–36 months). We found no significant difference in the occurrence of MACE between medical management of non-CLs and PCI of non-CLs (OR 1.10 95%CI 0.34, 3.56; p= 0.88). CABG however does show a trend to be superior to both PCI (OR 3.10 95%CI 0.54, 17.88; p= 0.21) and medical management (OR 2.83 95%CI 0.65, 12.27; P= 0.17) in non-CLs.CONCLUSIONS CABG appears superior to both PCI or medical management in preventing MACE over time, and PCI is not superior to medical management alone. |
| Databáze: | OpenAIRE |
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