Comparison of Outcomes of Staged Complete Revascularization Versus Culprit Lesion-Only Revascularization for ST-Elevation Myocardial Infarction and Multivessel Coronary Artery Disease
| Autor: | Ilaria De Pascali, Gaetano M. De Ferrari, Alessandra Repetto, Gabriele Crimi, Marco Ferlini, Sergio Leonardi, Andrea Demarchi, Maurizio Ferrario, Massimiliano Gnecchi, Stefano De Servi, L. O. Visconti, Rita Camporotondo, Marcello Marino, Francesca Falcinella |
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| Rok vydání: | 2016 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Coronary Artery Disease Kaplan-Meier Estimate 030204 cardiovascular system & hematology Revascularization Culprit Coronary artery disease 03 medical and health sciences 0302 clinical medicine Percutaneous Coronary Intervention Internal medicine Cause of Death Clinical endpoint Medicine Humans cardiovascular diseases 030212 general & internal medicine Myocardial infarction Mortality Propensity Score Aged Proportional Hazards Models Retrospective Studies business.industry Hazard ratio Percutaneous coronary intervention Middle Aged medicine.disease Surgery Conventional PCI Cardiology ST Elevation Myocardial Infarction Female business Cardiology and Cardiovascular Medicine |
| Zdroj: | The American journal of cardiology. 119(4) |
| ISSN: | 1879-1913 |
| Popis: | The management of noninfarct-related arteries in patients with ST-elevation myocardial infarction (STEMI) and multivessel coronary disease (MVD) is still debated. We evaluated the prognostic impact of staged complete revascularization with percutaneous coronary intervention (PCI) in STEMI patients with MVD admitted to our hospital from 2005 to 2013. Patients undergoing staged complete revascularization (n = 300) were compared with 1:1 propensity score–matched patients with culprit lesion–only treatment (n = 300). We considered a composite primary end point of all-cause death, myocardial infarction, and urgent PCI. Secondary end points included components of the primary, cardiovascular death, any PCI excluding staged PCI. We also performed an analysis including only patients surviving at least 5 days. The median follow-up was 553 days. The primary end point occurred in 10.3% of patients in the staged complete revascularization group and in 16.3% of patients in the culprit lesion–only group (hazard ratio 0.61, 95% CI 0.38 to 0.95, p = 0.031). Although this difference was no longer significant when considering only the survivors at day 5, all-cause and cardiovascular mortalities were still reduced in the staged complete revascularization group. Complete revascularization was associated with a better outcome (hazard ratio 0.35, 95% CI 0.17 to 0.63, p = 0.005) if performed within 30 days of STEMI. In conclusion, compared with culprit lesion–only revascularization, in STEMI patients with MVD undergoing primary PCI, an approach of staged complete revascularization was associated with a better outcome. |
| Databáze: | OpenAIRE |
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