title: Multivessel versus culprit vessel percutaneous coronary intervention in ST-elevation myocardial infarction: is more worse?
abstract: OBJECTIVE
  We examined what type of STEMI patients are more likely to undergo multivessel PCI (MPCI) in a "real-world" setting and whether MPCI leads to worse or better outcomes compared with single-vessel PCI (SPCI) after stratifying patients by risk.
  
  
  RESULTS
  Among STEMI patients enrolled in the Swiss AMIS Plus registry between 2005 and 2012 (n=12,000), 4,941 were identified with multivessel disease. We then stratified patients based on MPCI use and their risk. High-risk patients were identified a priori as those with: 1) left main (LM) involvement (lesions, n=263); 2) out-of-hospital cardiac arrest; or 3) Killip class III/IV. Logistic regression models examined for predictors of MPCI use and the association between MPCI and in-hospital mortality. Three thousand eight hundred and thirty-three (77.6%) patients underwent SPCI and 1,108 (22.4%) underwent MPCI. Rates of MPCI were greater among high-risk patients for each of the three categories: 8.6% vs. 5.9% for out-of-hospital cardiac arrest (p<0.01); 12.3% vs. 6.2% for Killip III/IV (p<0.001); and 14.5% vs. 2.7% for LM involvement (p<0.001). Overall, in-hospital mortality after MPCI was higher when compared with SPCI (7.3% vs. 4.4%; p<0.001). However, this result was not present when patients were stratified by risk: in-hospital mortality for MPCI vs. SPCI was 2.0% vs. 2.0% (p=1.00) in low-risk patients and 22.2% vs. 21.7% (p=1.00) in high-risk patients.
  
  
  CONCLUSIONS
  High-risk patients are more likely to undergo MPCI. Furthermore, MPCI does not appear to be associated with higher mortality after stratifying patients based on their risk.
authors.affiliation: Department of Cardiology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Milosz
authors.initials: M
authors.lastname: Jaguszewski
authors.forename: Dragana
authors.initials: D
authors.lastname: Radovanovic
authors.forename: Brahmajee K
authors.initials: BK
authors.lastname: Nallamothu
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Lüscher
authors.forename: Philip
authors.initials: P
authors.lastname: Urban
authors.forename: Franz R
authors.initials: FR
authors.lastname: Eberli
authors.forename: Osmund
authors.initials: O
authors.lastname: Bertel
authors.forename: Giovanni B
authors.initials: GB
authors.lastname: Pedrazzini
authors.forename: Stephan
authors.initials: S
authors.lastname: Windecker
authors.forename: Raban
authors.initials: R
authors.lastname: Jeger
authors.forename: Paul
authors.initials: P
authors.lastname: Erne
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery*; D003331:Coronary Vessels / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000379:methods; D012307:Risk Factors; D016896:Treatment Outcome