Long‐term outcome in patients with ST segment elevation myocardial infarction and multivessel disease treated with culprit‐only, immediate, or staged multivessel percutaneous revascularization strategies: Insights from the REAL registry. Issue 6 (1st February 2014)

• Record Type: Journal Article
• Authors: Manari, Antonio; Varani, Elisabetta; Guastaroba, Paolo; Menozzi, Mila; Valgimigli, Marco; Menozzi, Alberto; Magnavacchi, Paolo; Franco, Nicoletta; Marzocchi, Antonio; Casella, Gianni
• Is Part Of: Catheterization and cardiovascular interventions. Volume 84:Issue 6(2014:Nov. 15)
• Page Start: 912
• Page End: 922
• Publication Date: 2014-02-01
• Subjects: Heart -- Diseases -- Diagnosis -- Periodicals; Cardiac catheterization -- Periodicals; 616.1207572
• DOI: 10.1002/ccd.25374
• Languages: English
• ISSNs: 1522-1946

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="ccd25374-sec-0001" sec-type="section"> <title>Objectives</title> <p>To examine the differences in cardiac outcomes for patients with ST‐elevation myocardial infarction (STEMI) and multivessel disease (MVD) as a function of whether they underwent culprit‐only primary percutaneous coronary intervention (PPCI) or multivessel PCI, either during PPCI or as a staged procedure.</p> </sec> <sec id="ccd25374-sec-0002" sec-type="section"> <title>Background</title> <p>MVD occurs in about 40% of patients presenting with STEMI, and it has been associated with a worse outcome compared to single‐vessel disease. The most favorable PCI strategy for dealing with significant nonculprit lesions has to be established.</p> </sec> <sec id="ccd25374-sec-0003" sec-type="section"> <title>Methods</title> <p>A total of 2061 STEMI patients with MVD undergoing PPCI, prospectively enrolled in the REAL Registry between July 2002 and December 2010, were considered: 706 underwent culprit‐only PPCI; 367 multivessel PCI during the index procedure; 988 had a staged PCI within 60 days. Mortality and outcomes were calculated at 30 days and 2 years.</p> </sec> <sec id="ccd25374-sec-0004" sec-type="section"> <title>Results</title> <p>At multivariate analysis, culprit‐only PPCI was associated with higher rates of cardiac outcomes as compared to staged multivessel PCI, taken as reference [Hazard Ratio (HR): 2.81, 95% confidence interval (CI): 1.34–5.89, <italic>P</italic> = 0.006 for 30‐day mortality, and HR: 1.93, 95% CI: 1.35–2.74, <italic>P</italic> = 0.0002 for 2‐year mortality, respectively]. Short‐term mortality rates were higher in multivessel PCI group as compared to staged PCI group (HR: 2.58, 95% CI: 1.06–6.26, <italic>P</italic> = 0.03); no differences were observed at 2‐year follow‐up (HR: 1.08, 95% CI: 0.64–1.82, <italic>P</italic> = 0.76).</p> </sec> <sec id="ccd25374-sec-0005" sec-type="section"> <title>Conclusions</title> <p>Our findings support the current guidelines recommendation to perform culprit‐only PPCI in STEMI patients with MVD without hemodynamic compromise, followed by a staged PCI of noninfarct‐related significant lesions. © 2014 Wiley Periodicals, Inc.</p> </sec> </abstract>