Acute multivessel revascularization improves 1-year outcome in ST-elevation myocardial infarction: a nationwide study cohort from the AMIS Plus registry.
BACKGROUND
The optimal strategy for percutaneous coronary intervention (PCI) of ST-segment elevation myocardial infarction (STEMI) in multi-vessel disease (MVD), i.e., multi-vessel PCI (MV-PCI) vs. PCI of the infarct-related artery only (IRA-PCI), still remains unknown.


METHODS
Patients of the AMIS Plus registry admitted with an acute coronary syndrome were contacted after a median of 378 days (interquartile range 371-409). The primary end-point was all-cause death. The secondary end-point included all major adverse cardiovascular and cerebrovascular events (MACCE) including death, re-infarction, re-hospitalization for cardiac causes, any cardiac re-intervention, and stroke.


RESULTS
Between 2005 and 2012, 8330 STEMI patients were identified, of whom 1909 (24%) had MVD. Of these, 442 (23%) received MV-PCI and 1467 (77%) IRA-PCI. While all-cause mortality was similar in both groups (2.7% both, p>0.99), MACCE was significantly lower after MV-PCI vs. IRA-PCI (15.6% vs. 20.0%, p=0.038), mainly driven by lower rates of cardiac re-hospitalization and cardiac re-intervention. Patients undergoing MV-PCI with drug-eluting stents had lower rates of all-cause mortality (2.1% vs. 7.4%, p=0.026) and MACCE (14.1% vs. 25.9%, p=0.042) compared with those receiving bare metal stents (BMS). In multivariate analysis, MV-PCI (odds ratio, OR 0.69, 95% CI 0.51-0.93, p=0.017) and comorbidities (Charlson index ≥ 2; OR 1.42, 95% CI 1.05-1.92, p=0.025) were independent predictors for 1-year MACCE.


CONCLUSIONS
In an unselected nationwide real-world cohort, an approach using immediate complete revascularization may be beneficial in STEMI patients with MVD regarding MACCE, specifically when drug-eluting stents are used, but not regarding mortality. This has to be tested in a randomized controlled trial.
Cardiology, University Hospital, Basel, Switzerland.
Raban
R
Jeger
University Heart Center, University Hospital Zurich, Switzerland.
Milosz
M
Jaguszewski
Division of Cardiovascular Diseases, University of Michigan, Ann Arbor, USA.
Brahmajee N
BN
Nallamothu
University Heart Center, University Hospital Zurich, Switzerland.
Thomas F
TF
Lüscher
Cardiovascular Department, Hôpital de La Tour, Geneva, Switzerland.
Philip
P
Urban
Cardiology, CardioCentro Ticino, Lugano, Switzerland.
Giovanni B
GB
Pedrazzini
Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland; AMIS Plus Data Center, Institute of Social and Preventive Medicine, University of Zurich, Switzerland. Electronic address: paul.erne@erne-net.ch.
Paul
P
Erne
AMIS Plus Data Center, Institute of Social and Preventive Medicine, University of Zurich, Switzerland.
Dragana
D
Radovanovic
D000368:Aged; D002561:Cerebrovascular Disorders / Q000401:mortality; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D054855:Drug-Eluting Stents / Q000706:statistics & numerical data*; D004562:Electrocardiography; D005260:Female; D005440:Fluid Therapy / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care; D062645:Percutaneous Coronary Intervention / Q000401:mortality*; D011237:Predictive Value of Tests; D012042:Registries / Q000706:statistics & numerical data*; D012307:Risk Factors; D020521:Stroke / Q000401:mortality
Complete revascularization; Drug eluting stents; Multi-vessel disease; STEMI