Immediate multivessel intervention versus culprit-vessel intervention only in patients with ST-elevation myocardial infarction and multivessel coronary disease: data from the prospective KAMIR-NIH registry. Issue 2 (March 2019)

• Record Type: Journal Article
• Authors: Ahn, Sung Gyun; Lee, Jun-Won; Kang, Dae Ryong; Kim, Hye Sim; Go, Tae-Hwa; Yu, Min Heui; Kim, Ju Han; Jung, Myung Ho; Park, Jong-Seon; Chae, Shung Chull; Cho, Myeng-Chan; Kim, Chong Jin; Gwon, Hyeon-Cheol; Kim, Hyo-Soo; Seung, Ki Bae; Cha, Kwang Soo; Chae, Jei Keon; Joo, Seung Jae; Rha, Seung Woon; Choi, Dong-Ju; Hur, Seung Ho; Seong, In Whan; Kim, Doo Il; Oh, Seok Kyu; Ahn, Tae Hoon; Hwang, Jin Yong; Yoon, Junghan
• Is Part Of: Coronary artery disease. Volume 30:Issue 2(2019:Mar.)
• Publication Date: 2019-03
• Subjects: multivessel disease -- revascularization -- ST-elevation myocardial infarction; Coronary heart disease -- Periodicals; Coronary Disease -- Indexes; Coronary Disease -- Periodicals; 616.123005
• DOI: 10.1097/MCA.0000000000000684
• Languages: English
• ISSNs: 0954-6928

Abstract

Abstract : Background: The safety and efficacy of immediate multivessel coronary intervention (MVI) remain controversial in patients with ST-elevation myocardial infarction (STEMI) and multivessel disease (MVD). This study aimed to investigate the clinical outcomes of immediate MVI compared with culprit-vessel intervention only (CVI-O) in diverse subgroups with STEMI and MVD. Patients and methods: We compared immediate MVI ( n =260) and CVI-O ( n =931) regarding 1-year major adverse cardiac event rates for cardiac death, recurrent myocardial infarction (MI), and repeat revascularization in 1191 STEMI patients with MVD using data from the Korea Acute Myocardial Infarction-National Institutes of Health registry (2011–2015). High-risk patients and those who underwent a staged procedure were excluded from the analysis. Furthermore, propensity score matching and stratified subgroup analyses were performed. Results: Immediate MVI and CVI-O groups had similar 1-year major adverse cardiac event rates [7.7 vs. 8.9%, hazard ratio (HR): 0.86, 95% confidence interval (CI): 0.50–1.47, log-rank P =0.5628]. No difference was found between the groups in terms of the 1-year rate of cardiac death (2.9 vs. 1.3%, HR: 2.24, 95% CI: 0.75–6.67) or recurrent MI (2 vs. 1.5%, HR: 1.41, 95% CI: 0.45–4.44). However, repeat revascularization occurred less frequently in the immediate MVI group than in the CVI-O group (2.0 vs. 5.7%, HR: 0.35, 95% CI: 0.13–0.90, log-rank P =0.0142). These findings were found to be consistent across a broad spectrum of subgroups. Conclusion: Compared with CVI-O, immediate MVI did not improve 1-year net clinical outcomes in stable STEMI patients with MVD. The only benefit found was a reduced repeat revascularization in immediate MVI.