Multivessel versus culprit vessel percutaneous coronary intervention in ST-elevation myocardial infarction: is more worse?

Jaguszewski, Milosz; Radovanovic, Dragana; Nallamothu, Brahmajee K; Lüscher, Thomas F; Urban, Philip; Eberli, Franz R; Bertel, Osmund; Pedrazzini, Giovanni B; Windecker, Stephan; Jeger, Raban; Erne, Paul (2013). Multivessel versus culprit vessel percutaneous coronary intervention in ST-elevation myocardial infarction: is more worse? EuroIntervention, 9(8), pp. 909-915. Europa Digital & Publishing

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Aims: We examined what type of STEMI patients are more likely to undergo multivessel PCI (MPCI) in a "real-world" setting and whether MPCI leads to worse or better outcomes compared with single-vessel PCI (SPCI) after stratifying patients by risk. Methods and results: Among STEMI patients enrolled in the Swiss AMIS Plus registry between 2005 and 2012 (n=12,000), 4,941 were identified with multivessel disease. We then stratified patients based on MPCI use and their risk. High-risk patients were identified a priori as those with: 1) left main (LM) involvement (lesions, n=263); 2) out-of-hospital cardiac arrest; or 3) Killip class III/IV. Logistic regression models examined for predictors of MPCI use and the association between MPCI and in-hospital mortality. Three thousand eight hundred and thirty-three (77.6%) patients underwent SPCI and 1,108 (22.4%) underwent MPCI. Rates of MPCI were greater among high-risk patients for each of the three categories: 8.6% vs. 5.9% for out-of-hospital cardiac arrest (p<0.01); 12.3% vs. 6.2% for Killip III/IV (p<0.001); and 14.5% vs. 2.7% for LM involvement (p<0.001). Overall, in-hospital mortality after MPCI was higher when compared with SPCI (7.3% vs. 4.4%; p<0.001). However, this result was not present when patients were stratified by risk: in-hospital mortality for MPCI vs. SPCI was 2.0% vs. 2.0% (p=1.00) in low-risk patients and 22.2% vs. 21.7% (p=1.00) in high-risk patients. Conclusions: High-risk patients are more likely to undergo MPCI. Furthermore, MPCI does not appear to be associated with higher mortality after stratifying patients based on their risk.

Item Type:	Journal Article (Original Article)
Division/Institute:	04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
UniBE Contributor:	Windecker, Stephan
Subjects:	600 Technology > 610 Medicine & health
ISSN:	1774-024X
Publisher:	Europa Digital & Publishing
Language:	English
Submitter:	Judith Liniger
Date Deposited:	24 Mar 2014 10:33
Last Modified:	05 Dec 2022 14:28
PubMed ID:	24384288
URI:	https://boris.unibe.ch/id/eprint/41638