title: Prima-vista multi-vessel percutaneous coronary intervention in haemodynamically stable patients with acute coronary syndromes: analysis of over 4.400 patients in the EHS-PCI registry.
abstract: BACKGROUND
  The role of adhoc multi-vessel percutaneous coronary intervention (MV-PCI) in patients with ST elevation myocardial infarction (STEMI) and non ST elevation acute coronary syndromes (NSTE-ACS) has not fully defined yet. Therefore, we sought to evaluate the impact of MV-PCI on in-hospital outcome of patients with MV disease presenting with ACS.
  
  
  RESULTS
  We evaluated 4, 457 haemodynamically stable patients with ACS and at least two major epicardial vessels with ≥70% stenosis of the contemporary Euro Heart Survey PCI registry. They were stratified into four categories: 419 STEMI and 734 NSTE-ACS patients undergoing MV-PCI and 2,118 STEMI and 1,186 NSTE-ACS patients undergoing culprit lesion (CL)-PCI only, respectively. In comparison to patients with CL-PCI hospital mortality was numerically lower among those undergoing MV-PCI for STEMI (1.4 versus 3.4%, P=0.03) and for NSTE-ACS (1.1 versus 2.1%, P=0.10). After adjustment for confounding variables no significant mortality difference was observed among patients treated with MV-PCI for STEMI (OR 0.48, 95%-CI 0.21-1.13) and for NSTE-ACS (OR 0.54, 95%-CI 0.24-1.22). However, the risk for non-fatal postprocedural myocardial infarction was markedly increased among patients undergoing MV-PCI for STEMI (8.8 versus 1.6%, P<0.0001) and for NSTE-ACS (5.3 versus 1.8%, P<0.0001).
  
  
  CONCLUSIONS
  In clinical practice MV-PCI in haemodynamically stable with ACS is used only in a minority of patients. There was no significant difference in hospital mortality between patients treated with MV- and CL-PCI, but MV-PCI was associated with a higher rate of postprocedural myocardial infarction.
authors.affiliation: Herzzentrum Ludwigshafen, Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg, Germany. bauer-timm@gmx.de
authors.forename: Timm
authors.initials: T
authors.lastname: Bauer
authors.forename: Uwe
authors.initials: U
authors.lastname: Zeymer
authors.forename: Matthias
authors.initials: M
authors.lastname: Hochadel
authors.forename: Helge
authors.initials: H
authors.lastname: Möllmann
authors.forename: Franz
authors.initials: F
authors.lastname: Weidinger
authors.forename: Ralf
authors.initials: R
authors.lastname: Zahn
authors.forename: Holger M
authors.initials: HM
authors.lastname: Nef
authors.forename: Christian W
authors.initials: CW
authors.lastname: Hamm
authors.forename: Jean
authors.initials: J
authors.lastname: Marco
authors.forename: Anselm K
authors.initials: AK
authors.lastname: Gitt
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D000368:Aged; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D011446:Prospective Studies; D012042:Registries; D016896:Treatment Outcome