Culprit-only or multivessel percutaneous coronary stenting in patients with non-ST-segment elevation acute coronary syndromes: one-year follow-up
| Autor: | Anibal Damonte, Alejandro Meiriño, Ernesto Paolasso, Sabrina Carbó, Gerardo O. Zapata, Analia Pollice, Maximiliano Rossi, Eduardo Picabea, Leandro I. Lasave, Fernando Kozak |
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| Rok vydání: | 2009 |
| Předmět: |
Male
medicine.medical_specialty Acute coronary syndrome Time Factors medicine.medical_treatment Coronary Artery Disease Kaplan-Meier Estimate Revascularization Culprit Coronary artery disease Internal medicine Angioplasty medicine Humans Radiology Nuclear Medicine and imaging cardiovascular diseases Myocardial infarction Prospective Studies Acute Coronary Syndrome Angioplasty Balloon Coronary business.industry Incidence Percutaneous coronary intervention Middle Aged medicine.disease Surgery Logistic Models Multivariate Analysis Cardiology Female Stents Cardiology and Cardiovascular Medicine business Mace |
| Zdroj: | Journal of interventional cardiology. 22(4) |
| ISSN: | 1540-8183 |
| Popis: | Objective: To investigate the major cardiac events at 1-year follow-up of multivessel versus culprit-vessel stenting in patients presenting with non-ST elevation acute coronary syndrome (NSTE-ACS) and multivessel disease (MVD). Introduction: Percutaneous coronary intervention is a standard revascularization strategy for patients with NSTE-ACS. However, when these patients have MVD it is not clear whether multivessel (MVR) is superior to culprit-vessel revascularization (CVR). Methods: We screened 1,100 consecutive patients with NSTE-ACS from an institutional database. Comparisons of 1-year outcomes between multivessel and culprit-vessel revascularized patients were made. The primary outcome was the composite (MACE) of death, myocardial infarction (MI), or any revascularization. Secondary end-points were the components of the composite end-point. Regression analysis was performed to detect predictors of MACE. Results: A total of 609 patients were considered for this analysis: 204 (33.5%) and 405 (66.5%) had MVR and CVR treatment, respectively. The strategy adopted was based on a clinical decision. The incidence of MACE was lower in MVR (9.45% vs. 16.34%, P = 0.02) with lower revascularization rate (7.46% vs. 13.86%, P = 0.04) than in CVR. There was no difference in death (1.99% vs. 1.98%, P = 0.8) nor death/MI (2.49% vs. 3.22%, P = 0.8) between MVR and CVR, respectively. Multivariate analysis showed CVR as the only independent predictor of improved MACE (OR 0.66, CI95% 1.12–3.47, P = 0.01). Conclusion: Multivessel stenting in patients with NSTE-ACS and multivessel disease using a clinical decision of treatment is associated with lower rate of MACE driven by lower repeat revascularization, compared with culprit-vessel stenting, without difference in rates of death or MI. |
| Databáze: | OpenAIRE |
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