Non-culprit coronary artery percutaneous coronary intervention during acute ST-segment elevation myocardial infarction: insights from the APEX-AMI trial.
OBJECTIVE
To examine the incidence of and propensity for non-culprit interventions performed at the time of the primary percutaneous coronary intervention (PCI) and its association with 90-day outcomes.


RESULTS
We examined the incidence, propensity for, and associated 90-day outcomes following non-culprit interventions performed at the time of primary PCI among ST-elevation myocardial infarction patients with multi-vessel coronary artery disease (MVD). Of the 5373 patients who underwent primary PCI in the APEX-AMI trial, 2201 had MVD. Of those, 217 (9.9%) underwent non-infarct-related arteries (IRA) PCI, whereas 1984 (90.1%) underwent PCI of the IRA alone. Ninety-day death and death/CHF/shock were higher in the non-IRA group compared with the IRA-only PCI group (12.5 vs. 5.6%, P (log-rank) < 0.001 and 17.4 vs. 12.0%, P (log-rank) = 0.020, respectively). After adjusting for patient and procedural characteristics as well as propensity for performing non-IRA PCI, this procedure remained independently associated with an increased hazard of 90-day mortality [adjusted hazard ratio 2.44, 95% CI (1.55-3.83), P < 0.001].


CONCLUSIONS
Non-culprit coronary interventions were performed at the time of primary PCI in 10% of MVD patients and were significantly associated with increased mortality. Our data support current guideline recommendations discouraging the performance of such procedures in stable primary PCI patients. Prospective randomized study of this issue may be warranted.
Toma
Mustafa
M
Canadian VIGOUR Centre, University of Alberta, 2-51 Medical Sciences Building, Edmonton, AB, Canada T6G 2H7.
Buller
Christopher E
CE
Westerhout
Cynthia M
CM
Fu
Yuling
Y
O'Neill
William W
WW
Holmes
David R
DR
Hamm
Christian W
CW
Granger
Christopher B
CB
Armstrong
Paul W
PW
D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D003324:Coronary Artery Disease / Q000401:mortality / Q000628:therapy*; D005260:Female; D006333:Heart Failure / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D057216:Propensity Score; D016032:Randomized Controlled Trials as Topic; D012770:Shock, Cardiogenic / Q000401:mortality; D055815:Young Adult