title: Multivessel approach in ST-elevation myocardial infarction: impact on in-hospital morbidity and mortality.
abstract: BACKGROUND
  Multivessel disease in ST-elevation myocardial infarction (STEMI) is associated with a worse prognosis. A multivessel approach at the time of primary percutaneous coronary intervention (PCI) is the subject of debate.
  
  
  OBJECTIVE
  To assess the impact of a multivessel approach on in-hospital morbidity and mortality in patients with STEMI undergoing primary PCI.
  
  
  METHODS
  We studied patients from the Portuguese Registry of Acute Coronary Syndromes with STEMI and multivessel disease who underwent primary PCI. The 257 patients were divided into two groups: those who underwent PCI of the culprit artery only and those who underwent multivessel PCI. Cardiovascular risk factors, STEMI location, in-hospital treatment, number and type of diseased and treated arteries, type of stent implanted and ejection fraction were recorded. The primary end-point was defined as in-hospital mortality and the secondary end-point as the presence of at least one of the following complications: major bleeding, need for transfusion, invasive ventilation, heart failure and reinfarction.
  
  
  RESULTS
  Multivessel disease was found in 43.3% of the study population and a multivessel approach was adopted in 19.2% of these patients. There were no differences between the groups in cardiovascular risk factors or electrocardiographic presentation of STEMI. Patients undergoing multivessel PCI were more likely to be treated with drug-eluting stents and glycoprotein IIb/IIIa inhibitors, and less likely to receive heparin therapy. There were no differences between the groups with regard to in-hospital mortality or the incidence of complications.
  
  
  CONCLUSIONS
  In our population of patients with STEMI, a multivessel approach appears to be safe and not associated with increased in-hospital mortality or morbidity.
authors: Serviço de Cardiologia, Hospital do Espírito Santo, Évora, Portugal. Electronic address: anarita_asantos@hotmail.com.
authors: Ana Rita
authors: AR
authors: Santos
authors: Serviço de Cardiologia, Hospital do Espírito Santo, Évora, Portugal.
authors: Bruno Cordeiro
authors: BC
authors: Piçarra
authors: Serviço de Cardiologia, Hospital do Espírito Santo, Évora, Portugal.
authors: Margarida
authors: M
authors: Celeiro
authors: Serviço de Cardiologia, Hospital do Espírito Santo, Évora, Portugal.
authors: Ângela
authors: Â
authors: Bento
authors: Serviço de Cardiologia, Hospital do Espírito Santo, Évora, Portugal.
authors: José
authors: J
authors: Aguiar
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000150:complications; D004562:Electrocardiography; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D062645:Percutaneous Coronary Intervention
keywords: Acute myocardial infarction; Angioplastia primária; Doença multivaso; Enfarte agudo do miocárdio; Multivessel disease; Primary percutaneous coronary intervention; Prognosis; Prognóstico