Culprit only or multivessel percutaneous coronary interventions in patients with ST-segment elevation myocardial infarction and multivessel disease.
OBJECTIVE
In patients with ST-segment elevation myocardial infarction (STEMI), timely reperfusion with primary percutaneous coronary intervention (PPCI) is the preferred treatment. However, it remains unclear whether the optimal strategy is complete revascularisation or culprit vessel PPCI only.


RESULTS
From January 2002 to June 2009 all patients treated with PPCI were identified from the Western Denmark Heart Registry. We examined mortality according to timing of multivessel PCI: acute procedure, staged procedure during the index hospitalisation, or staged procedure performed within 60 days. The hazard ratio (HR) for death was estimated using a time-dependent Cox regression model, with time of PCI for the non-culprit lesion as the time-dependent variable. The study cohort consisted of 5,944 patients, of whom 4,770 (80%) had single-vessel disease and 1,174 (20%) had multivessel PCI within 60 days. Among 354 (30.2%) patients with acute multivessel PCI, 194 (16.5%) patients with multivessel PCI during the index hospitalisation, and 626 (53.3%) patients with multivessel PCI within 60 days after the index hospitalisation, the adjusted HRs for one-year mortality were 1.53 (95% confidence interval (CI): 1.07-2.18), 0.60 (95% CI: 0.28-1.26), and 0.28 (95% CI: 0.14-0.54), respectively, compared to patients with single vessel disease.


CONCLUSIONS
Acute multivessel PCI in patients with STEMI was associated with increased mortality.
Department of Cardiology, Odense University Hospital, Denmark. okkels@dadlnet.dk
Lisette Okkels
LO
Jensen
Per
P
Thayssen
Dóra Körmendiné
DK
Farkas
Mikkel
M
Hougaard
Christian Juhl
CJ
Terkelsen
Hans-Henrik
HH
Tilsted
Michael
M
Maeng
Anders
A
Junker
Jens Flensted
JF
Lassen
Erzsébet
E
Horváth-Puhó
Henrik Toft
HT
Sørensen
Leif
L
Thuesen
D000368:Aged; D015331:Cohort Studies; D003718:Denmark; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D012042:Registries; D012044:Regression Analysis; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000401:mortality / Q000628:therapy*