title: Coronary revascularization strategy for ST elevation myocardial infarction with multivessel disease: experience and results at 1-year follow-up.
abstract: Primary percutaneous coronary intervention (PCI) of culprit lesions (CLs) is the standard of care in patients presenting with ST elevation myocardial infarction (STEMI). However, optimal revascularization strategy for significant nonculprit lesions (non-CLs) in the setting of STEMI remains controversial. The importance of defining of such a strategy lies in the fact that approximately 50% of patients with STEMI have multivessel disease (MVD). The aim of this study was to describe characteristics, therapeutic strategies, and 1-year outcomes in a cohort of patients with STEMI and MVD. We retrospectively analyzed a cohort of 63 patients with STEMI and MVD obtained from a 5-year catheterization database. MVD was defined as ≥70% stenosis of ≥2 epicardial coronary arteries. This cohort was followed for a period of 1 year for major adverse cardiac events (MACE was defined as acute coronary syndrome, new onset heart failure, or death) and all-cause mortality. PCI with stent placement was the major therapeutic procedure (87.5%) performed for CLs. Non-CLs did not undergo interventions in a majority of individuals (47.6%), while the remaining patients underwent PCI (29%) and coronary artery bypass graft surgery (22%) for non-CLs. At 1-year follow-up, prevalence of MACE events and death in the entire cohort were 30% and 15%, respectively. A trend for better outcomes (1-year cumulative MACE events but not mortality) was observed in CL-only intervention cohort compared with non-CL intervention. The PCI and Coronary artery bypass graft surgery cohorts did not show any significant difference in clinical outcomes. In this retrospective cohort of patients with MVD who presented with STEMI, no intervention of noncritical lesions was the prevalent approach, reflecting guideline recommendations. CL-only intervention strategy showed a better clinical outcome than non-CL intervention. Intervention of noncritical lesions therefore did not seem to improve MACEs or all-cause mortality at 1-year of follow-up and might in fact have had a detrimental effect on outcomes.
authors.affiliation: Division of Cardiology, Wayne State University, Harper University Hospital, Detroit, MI 48201, USA. tamamns@yahoo.com
authors.forename: Tamam
authors.initials: T
authors.lastname: Mohamad
authors.forename: Juan M
authors.initials: JM
authors.lastname: Bernal
authors.forename: Ashok
authors.initials: A
authors.lastname: Kondur
authors.forename: Pawan
authors.initials: P
authors.lastname: Hari
authors.forename: Katrina
authors.initials: K
authors.lastname: Nelson
authors.forename: Ashutosh
authors.initials: A
authors.lastname: Niraj
authors.forename: Apurva
authors.initials: A
authors.lastname: Badheka
authors.forename: Samer
authors.initials: S
authors.lastname: Hassna
authors.forename: Tom
authors.initials: T
authors.lastname: Kiernan
authors.forename: Mahir D
authors.initials: MD
authors.lastname: Elder
authors.forename: Delair
authors.initials: D
authors.lastname: Gardi
authors.forename: Theodore
authors.initials: T
authors.lastname: Schreiber
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000379:methods*; D023921:Coronary Stenosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D019992:Databases as Topic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome