STEMI and Multivessel Disease: Medical Therapy Amplifies the Benefit of Complete Myocardial Revascularisation
Autor: | Davide Stolfo, Giulia Barbati, Andrea Pezzato, Andrea Perkan, Serena Rakar, Stefano Albani, Gianfranco Sinagra, Caterina Gregorio, Enrico Fabris, Luca Falco, Giancarlo Vitrella |
---|---|
Přispěvatelé: | Fabris, E., Pezzato, A., Gregorio, C., Barbati, G., Falco, L., Albani, S., Stolfo, D., Vitrella, G., Rakar, S., Perkan, A., Sinagra, G. |
Rok vydání: | 2021 |
Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty medicine.medical_treatment Population Myocardial Infarction Coronary Artery Disease Beta blockers Non-culprit lesion PCI Renin-angiotensin system inhibitors STEMI Percutaneous Coronary Intervention Internal medicine Myocardial Revascularization medicine Humans cardiovascular diseases Myocardial infarction education Beta blocker education.field_of_study business.industry Myocardial revascularisation Percutaneous coronary intervention Multivessel disease medicine.disease Renin-angiotensin system inhibitor Treatment Outcome Conventional PCI Propensity score matching Cardiology ST Elevation Myocardial Infarction Cardiology and Cardiovascular Medicine business Medical therapy |
Zdroj: | Heart, Lung and Circulation. 30:1846-1853 |
ISSN: | 1443-9506 |
Popis: | Background Patients with ST-elevation myocardial infarction (STEMI) with multivessel disease (MVD) may be treated with different revascularisation strategies. However, the potential predictors of outcomes on top of different revascularisation strategies are poorly studied. This study aimed to evaluate the prognostic impact of two different revascularisation strategies and the potential impact of medical therapy. Methods Using a propensity score approach, the impact of two treatment strategies was analysed –staged non-culprit revascularisation group vs culprit-lesion-only percutaneous coronary intervention (PCI) group -- on a composite outcome of cardiovascular death (CVD), myocardial infarction, and repeated revascularisation. Moreover, models were further adjusted for medication at discharge. Results Among 1,385 STEMI patients treated with primary PCI, a subgroup of 433 with MVD was analysed. At the median follow-up of 41 (IQR, 21–65) months, after propensity-score adjustment, the multivariable Cox proportional hazard analysis showed that the staged non-culprit revascularisation group was associated with a lower composite endpoint (HR, 0.44; 95% CI, 0.24–0.82; p=0.01), lower CVD (HR, 0.34; 95% CI, 0.14–0.82; p=0.02), and lower all-cause death (HR, 0.46; 95% CI, 0.24–0.86; p=0.02). Use of renin-angiotensin inhibitors was associated with lower CVD (HR, 0.51; 95% CI, 0.27–0.95; p=0.03), and both renin-angiotensin inhibitors (HR, 0.52; 95% CI, 0.32–0.86; p=0.01) and beta blockers (HR, 0.48; 95% CI, 0.29–0.79; p=0.01) were associated with lower all-cause death. Conclusions In a real-word STEMI population with multivessel disease, staged non-culprit revascularisation was associated with lower cardiovascular mortality compared with a culprit-only PCI strategy. However, both revascularisation and medical therapy played a role in the improvement of mortality outcomes. Medical therapy amplified the benefit of myocardial revascularisation. |
Databáze: | OpenAIRE |
Externí odkaz: |