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LI YX, WANG BN, FAN FF, ZHANG Y, JIANG J, LI JP, HAN YL, Huo Y. Thirty-day outcomes of in-hospital multi-vessel versus culprit-only revascularization strategy for ST-segment elevation myocardial infarction with multivessel coronary disease. J Geriatr Cardiol 2023; 20:485-494. [PMID: 37576484 PMCID: PMC10412540 DOI: 10.26599/1671-5411.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND Many studies have demonstrated the benefit of complete multivessel revascularization versus culprit-only intervention in patients of ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease. However, only a few single-center retrospective studies were performed on small Chinese cohorts. Our study aims to demonstrate the advantage of multivessel percutaneous intervention (PCI) strategy on 30-day in-hospital outcomes to patients with STEMI and multivessel disease in larger Chinese population. METHODS From the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome (CCC-ACS) project, 5935 patients with STEMI and multivessel disease undergoing PCI and hospitalized for fewer than 30 days were analyzed. After 5: 1 propensity score matching, 3577 patients with culprit-only PCI and 877 with in-hospital multivessel PCI were included. The primary outcome was major adverse cardiovascular and cerebrovascular event (MACCE), defined as a composite of myocardial infarction, all-cause death, stent thrombosis, heart failure, and stroke. RESULTS Multivariable logistic regression analysis revealed that in-hospital multivessel PCI was associated with lower risk of 30-day MACCE (adjusted OR = 0.75, 95% CI: 0.57-0.98, P = 0.032) than culprit-only PCI and conferred no increased risk of all-cause death, myocardial infarction, stent thrombosis, stroke, or bleeding. Subgroup analysis showed that MACCE reduction was observed more often from patients with trans-femoral access (OR = 0.34, 95% CI: 0.15-0.74) than with trans-radial access (OR = 0.87, 95% CI: 0.66-1.16, P for interaction = 0.017). CONCLUSIONS The in-hospital multivessel PCI strategy was associated with a lower risk of 30-day MACCE than culprit-only PCI in patients with STEMI and multivessel coronary artery disease.
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Affiliation(s)
- Yu-Xi LI
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Bei-Ning WANG
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Fang-Fang FAN
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Yan ZHANG
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Jie JIANG
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Jian-Ping LI
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Ya-Ling HAN
- Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, Liaoning, China
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing, China
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de La Torre Hernandez JM, Gomez Hospital JA, Baz JA, Brugaletta S, Perez de Prado A, Linares JA, Lopez Palop R, Cid B, Garcia Camarero T, Diego A, Gutierrez H, Fernandez Diaz JA, Sanchis J, Alfonso F, Blanco R, Botas J, Navarro Cuartero J, Moreu J, Bosa F, Vegas JM, Elizaga J, Arrebola AL, Hernandez F, Salvatella N, Monteagudo M, Gomez Jaume A, Carrillo X, Martin Reyes R, Lozano F, Rumoroso JR, Andraka L, Dominguez AJ. Multivessel disease in patients over 75years old with ST elevated myocardial infarction. Current management strategies and related clinical outcomes in the ESTROFA MI+75 nation-wide registry. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:580-588. [PMID: 29306670 DOI: 10.1016/j.carrev.2017.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 12/03/2017] [Accepted: 12/05/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND In elderly patients with ST elevated myocardial infarction (STEMI) and multivessel disease (MVD the outcomes related with different revascularization strategies are not well known. METHODS Subgroup-analysis of a nation-wide registry of primary angioplasty in the elderly (ESTROFA MI+75) with 3576 patients over 75years old from 31 centers. Patients with MVD were analyzed to describe treatment approaches and 2years outcomes. RESULTS Of 1830 (51%) with MVD, 847 (46%) underwent multivessel revascularization either in acute (51%), staged (44%) or both procedures (5%). Patients with previous myocardial infarction and those receiving drug-eluting stents or IIb-IIIa inhibitors were more prone to be revascularized, whereas older patients, females and those with Killip III-IV, renal failure and higher ejection fraction were less likely. Survival free of cardiac death and infarction at 2years was better for those undergoing multivessel PCI (85.8% vs. 80.4%, p<0.0008), regardless of Killip class. Multivessel PCI was protective of cardiac death and infarction (HR 0.60, 95% CI 0.40-0.89; p=0.011). Complete revascularization made no difference in outcomes among those patients undergoing multivessel PCI. The best prognosis corresponded to those undergoing multivessel PCI in staged procedures (p<0.001). A propensity score matching analysis (514 patients in each group) yielded similar results. CONCLUSIONS In elderly patients with STEMI and MVD, multivessel PCI was related with better outcomes especially after staged procedures. Among those undergoing multivessel PCI, anatomically defined completeness of revascularization had not prognostic influence. SUMMARY We sought to investigate the revascularization strategies applied and their prognostic implications in patients aged over 75years with ST elevated myocardial infarction showing multivessel disease. Of 1830 patients, 847 (46%) underwent multivessel PCI either in acute (51%), staged (44%) or both procedures (5%). Multivessel PCI was independent predictor of cardiac death and infarction with the best prognosis corresponding to those undergoing staged procedures.
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Affiliation(s)
| | | | - Jose A Baz
- Hospital de Vigo, Servicio de Cardiologia, Vigo, Spain
| | | | | | - Jose A Linares
- Hospital Clinico de Zaragoza, Servicio de Cardiologia, Zaragoza, Spain
| | | | - Belen Cid
- Hospital de Santiago de Compostela, Servicio de Cardiologia, Santiago de Compostela, Spain
| | | | - Alejandro Diego
- Hospital Clinico de Salamanca, Servicio de Cardiologia, Salamanca, Spain
| | - Hipolito Gutierrez
- Hospital Clinico de Valladolid, Servicio de Cardiologia, Valladolid, Spain
| | | | - Juan Sanchis
- Hospital Clinico de Valencia, Servicio de Cardiologia, Valencia, Spain
| | | | - Roberto Blanco
- Hospital de Cruces, Bilbao, Servicio de Cardiologia, Spain
| | - Javier Botas
- Hospital de Alcorcon, Servicio de Cardiologia, Alcorcon, Spain
| | | | - Jose Moreu
- Hospital Virgen de la Salud, Servicio de Cardiologia, Toledo, Spain
| | - Francisco Bosa
- Hospital Clinico de Tenerife, Servicio de Cardiologia, Santa Cruz de Tenerife, Spain
| | - Jose M Vegas
- Hospital de Cabueñes, Servicio de Cardiologia, Gijon, Spain
| | - Jaime Elizaga
- Hospital Gregorio Marañon, Servicio de Cardiologia, Madrid, Spain
| | | | | | - Neus Salvatella
- Hospital del Mar, Servicio de Cardiología, Grup de Recerca Biomèdica en Malalties del Cor, IMIM (Hospital del Mar Reseach Institute), Barcelona, Spain
| | | | | | - Xavier Carrillo
- Hospital Germans Trias i Pujol, Servicio de Cardiologia, Badalona, Spain
| | | | - Fernando Lozano
- Hospital de Ciudad Real, Servicio de Cardiologia, Ciudad Real, Spain
| | - Jose R Rumoroso
- Hospital de Galdacano, Servicio de Cardiologia, Bilbao, Spain
| | - Leire Andraka
- Hospital de Basurto, Servicio de Cardiologia, Bilbao, Spain
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