title: Long-term impact of multivessel disease on cause-specific mortality after ST elevation myocardial infarction treated with reperfusion therapy.
abstract: OBJECTIVE
  To investigate the long-term impact of multivessel coronary artery disease (MVD) on cause-specific mortality in patients with ST elevation myocardial infarction (STEMI) treated with reperfusion therapy.
  
  
  RESULTS
  Patients with STEMI (n = 395) treated with primary angioplasty or thrombolysis in the setting of a randomised clinical trial were enrolled in the study. Follow up was 8 (2) years. For patients who died all available records were reviewed to assess the specific cause of death. MVD was present in 57% of patients. Patients with MVD were older and more of them had diabetes and previous myocardial infarction. Compared with the non-MVD group, residual left ventricular ejection fraction was lower (45.9% v 49.6%, p = 0.001) and total mortality was higher in patients with MVD (32% v 19%, p = 0.002). After adjustment for potential confounders this association was not significant (hazard ratio 1.4, 95% confidence interval (CI) 0.9 to 2.2). When the specific cause of death was considered, sudden death was comparable between patients with and without MVD (10% v 8%, p = 0.49) but death caused by heart failure was significantly higher in patients with MVD (hazard ratio 7.4, 95% CI 1.7 to 32.2).
  
  
  CONCLUSIONS
  Patients with STEMI and MVD have a higher long-term mortality than do patients with non-MVD. MVD is not an independent predictor of long-term total mortality or sudden death. However, MVD is a very strong and independent predictor of long-term death caused by heart failure.
authors.affiliation: Department of Cardiology, Isala klinieken, locatie Weezenlanden, Zwolle, The Netherlands.
authors.forename: R J
authors.initials: RJ
authors.lastname: van der Schaaf
authors.forename: J R
authors.initials: JR
authors.lastname: Timmer
authors.forename: J P
authors.initials: JP
authors.lastname: Ottervanger
authors.forename: J C A
authors.initials: JC
authors.lastname: Hoorntje
authors.forename: M-J
authors.initials: MJ
authors.lastname: de Boer
authors.forename: H
authors.initials: H
authors.lastname: Suryapranata
authors.forename: F
authors.initials: F
authors.lastname: Zijlstra
authors.forename: J-H E
authors.initials: JH
authors.lastname: Dambrink
mesh_terms: D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000379:methods*; D015912:Thrombolytic Therapy / Q000379:methods; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000401:mortality / Q000628:therapy