title: Comparison of percutaneous coronary intervention for previously treated versus de novo culprit lesions in acute myocardial infarction patients: insights from the National Cardiovascular Data Registry.
abstract: BACKGROUND
  Little is known about percutaneous coronary intervention (PCI) outcomes among patients presenting with an acute myocardial infarction (MI) with a history of prior PCI. Outcomes may differ depending on whether PCI is performed on a previously treated or de novo culprit lesion.
  
  
  METHODS
  We examined ST-segment elevation myocardial infarction (STEMI) and non-STEMI patients who underwent PCI in the CathPCI Registry from 2009 to 2012. We used multivariable logistic regression to compare adjusted in-hospital mortality between groups.
  
  
  RESULTS
  Among 675,587 MI patients, 147,841 (22%) had a history of prior PCI; these patients were older and more frequently had co-morbid conditions yet had lower adjusted mortality compared with patients undergoing their first intervention (OR = 0.73, 95% CI = 0.70-0.76). Among patients with prior PCI, 50,744 (34%) received intervention to a culprit lesion in a previously treated segment. Compared with patients with de novo culprit lesions, those with previously treated culprits were more likely to present with STEMI, but had lower mortality risk (OR = 0.88, 95% CI = 0.82-0.95) regardless of STEMI or non-STEMI presentation. Among previously treated patients, in-hospital mortality was not significantly different between those with prior drug-eluting versus bare metal stent-treated culprit lesions (OR = 0.95, 95% CI = 0.81-1.12).
  
  
  CONCLUSIONS
  Despite greater co-morbidity burden, MI patients with prior PCI had lower mortality compared with patients undergoing their first intervention. Among patients with prior PCI, patients undergoing PCI to a previously treated culprit lesion were associated with lower mortality than those being intervened for a de novo culprit. A better understanding of these differences will help improve procedural strategies and outcomes of patients undergoing PCI of a previously treated lesion.
authors.affiliation: Duke Clinical Research Institute, Durham, NC; National Heart Centre Singapore, Singapore. Electronic address: chin.chee.tang@nhcs.com.sg.
authors.forename: Chee Tang
authors.initials: CT
authors.lastname: Chin
authors.affiliation: University of Colorado School of Medicine, Aurora, CO.
authors.forename: John C
authors.initials: JC
authors.lastname: Messenger
authors.affiliation: Duke Clinical Research Institute, Durham, NC.
authors.forename: David
authors.initials: D
authors.lastname: Dai
authors.affiliation: Duke Clinical Research Institute, Durham, NC.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: McCoy
authors.affiliation: Wake Forest University School of Medicine, Winston-Salem, NC.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Kutcher
authors.affiliation: University of Texas Health Science Center, Houston, TX.
authors.forename: H Vernon
authors.initials: HV
authors.lastname: Anderson
authors.affiliation: Duke Clinical Research Institute, Durham, NC.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Roe
authors.affiliation: Duke Clinical Research Institute, Durham, NC.
authors.forename: Tracy Y
authors.initials: TY
authors.lastname: Wang
mesh_terms: D000368:Aged; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D062645:Percutaneous Coronary Intervention; D012008:Recurrence; D012042:Registries; D012189:Retrospective Studies; D016896:Treatment Outcome