title: Outcomes from patients with multi-vessel disease following primary PCI: staged PCI imparts very low mortality.
abstract: BACKGROUND
  CABG and PCI are effective means for revascularization of patients with multi-vessel coronary artery disease, but previous studies have not focused on treatment of patients that first undergo primary PCI.
  
  
  METHODS
  Among patients enrolled in the global registry of acute coronary events (GRACE), clinical outcomes for patients presenting with STEMI treated with primary PCI were compared according to whether residual stenoses were treated medically, surgically, or with staged PCI. Clinical characteristics and data pertaining to major adverse cardiac events during hospitalization and 6 months after discharge were collected.
  
  
  RESULTS
  Of the 1,705 patients included, 1,345 (79%) patients were treated medically, 303 (18%) underwent staged PCI, and 57 (3.3%) underwent CABG following primary PCI. Hospital mortality was lowest among patients treated with staged PCI (Medical = 5.7%; PCI = 0.7%; CABG = 3.5%; P < 0.001 [PCI vs. Medical]), a finding that persisted after risk adjustment (Odds Ratio PCI vs. Medical 5 0.16, [0.04-0.68]; P 5 0.01). Six month postdischarge mortality likewise was lowest in the staged PCI group (Medical = 3.1%; PCI = 0.8%; CABG = 4.0%; P = 0.04 [PCI vs. Medical]). Patients revascularized surgically were rehospitalized less frequently (Medical = 20%; PCI = 19%; CABG = 6.3%; P < 0.05) and underwent fewer unscheduled procedures (Medical 5 9.8%; PCI = 10.0%; CABG = 0.0%; P < 0.02).
  
  
  CONCLUSIONS
  The results of this multinational registry demonstrate that hospital mortality in patients who undergo staged percutaneous revascularization of multivessel coronary disease following primary PCI is very low. Patients undergoing CABG following primary PCI are hospitalized less frequently and undergo fewer unplanned catheter-based procedures.
authors.affiliation: University of Massachusetts Medical School, Worcester, Massachusetts, USA. Barringk@ummhc.org
authors.forename: Kurt G
authors.initials: KG
authors.lastname: Barringhaus
authors.forename: Kay Lee
authors.initials: KL
authors.lastname: Park
authors.forename: David D
authors.initials: DD
authors.lastname: McManus
authors.forename: Philippe Gabriel
authors.initials: PG
authors.lastname: Steg
authors.forename: Gilles
authors.initials: G
authors.lastname: Montalescot
authors.forename: Frans
authors.initials: F
authors.lastname: Van de Werf
authors.forename: José
authors.initials: J
authors.lastname: López-Sendón
authors.forename: Gordon
authors.initials: G
authors.lastname: FitzGerald
authors.forename: Joel M
authors.initials: JM
authors.lastname: Gore
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000401:mortality*; D001315:Australia; D002317:Cardiovascular Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality*; D023921:Coronary Stenosis / Q000150:complications / Q000401:mortality / Q000628:therapy*; D005060:Europe; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D009520:New Zealand; D009656:North America; D016017:Odds Ratio; D018579:Patient Selection; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013020:South America; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents