Culprit Vessel Versus Multivessel Intervention at the Time of Primary Percutaneous Coronary Intervention in Patients With ST-Segment–Elevation Myocardial Infarction and Multivessel Disease : Real-World Analysis of 3984 Patients in London

Media type: E-Article
Title: Culprit Vessel Versus Multivessel Intervention at the Time of Primary Percutaneous Coronary Intervention in Patients With ST-Segment–Elevation Myocardial Infarction and Multivessel Disease : Real-World Analysis of 3984 Patients in London : Real-World Analysis of 3984 Patients in London
Contributor: Iqbal, M. Bilal; Ilsley, Charles; Kabir, Tito; Smith, Robert; Lane, Rebecca; Mason, Mark; Clifford, Piers; Crake, Tom; Firoozi, Sam; Kalra, Sundeep; Knight, Charles; Lim, Pitt; Malik, Iqbal S.; Mathur, Anthony; Meier, Pascal; Rakhit, Roby D.; Redwood, Simon; Whitbread, Mark; Bromage, Dan; Rathod, Krishna; MacCarthy, Philip; Dalby, Miles
imprint: Ovid Technologies (Wolters Kluwer Health), 2014
Published in: Circulation: Cardiovascular Quality and Outcomes
Language: English
DOI: 10.1161/circoutcomes.114.001194
ISSN: 1941-7705; 1941-7713
Keywords: Cardiology and Cardiovascular Medicine
Origination:
Footnote:
Description: <jats:sec> <jats:title>Background—</jats:title> <jats:p>It is estimated that up to two thirds of patients presenting with ST-segment–elevation myocardial infarction have multivessel disease. The optimal strategy for treating nonculprit disease is currently under debate. This study provides a real-world analysis comparing a strategy of culprit-vessel intervention (CVI) versus multivessel intervention at the time of primary percutaneous coronary intervention in patients with ST-segment–elevation myocardial infarction.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods and Results—</jats:title> <jats:p> We compared CVI versus multivessel intervention in 3984 patients with multivessel disease undergoing primary percutaneous coronary intervention between 2004 and 2011 at all 8 tertiary cardiac centers in London. Multivariable-adjusted models were built to determine independent predictors for in-hospital major adverse cardiovascular events (MACEs) and all-cause mortality at 1 year. To reduce confounding and bias, propensity score methods were used. CVI was associated with reduced in-hospital MACE (4.6% versus 7.2%; <jats:italic>P</jats:italic> =0.010) and mortality at 1 year (7.4% versus 10.1%; <jats:italic>P</jats:italic> =0.031). CVI was an independent predictor for reduced in-hospital MACE (odds ratio, 0.49; 95% confidence interval [CI], 0.32–0.75; <jats:italic>P</jats:italic> <0.001) and survival at 1 year (hazard ratio, 0.65; 95% CI, 0.47–0.91; <jats:italic>P</jats:italic> =0.011) in the complete cohort; and in 2821 patients in propensity-matched cohort (in-hospital MACE: odds ratio, 0.49; 95% CI, 0.32–0.76; <jats:italic>P</jats:italic> =0.002; and 1-year survival: hazard ratio, 0.64; 95% CI, 0.45–0.90; <jats:italic>P</jats:italic> =0.010). Inverse probability treatment weighted analyses also confirmed CVI as an independent predictor for reduced in-hospital MACE (odds ratio, 0.38; 95% CI, 0.15–0.96; <jats:italic>P</jats:italic> =0.040) and survival at 1 year (hazard ratio, 0.44; 95% CI, 0.21–0.93; <jats:italic>P</jats:italic> =0.033). </jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions—</jats:title> <jats:p>In this observational analysis of patients with ST-segment–elevation myocardial infarction undergoing primary percutaneous coronary intervention, CVI was associated with increased survival at 1 year. Acknowledging the limitations with observational analyses, our findings support current recommended practice guidelines.</jats:p> </jats:sec>
Access State: Open Access

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