Effect of revascularization strategy in patients with acute myocardial infarction and renal insufficiency with multivessel disease.
OBJECTIVE
The aim of this study was to compare the risk of complications and outcome between infarct-related artery (IRA)-only revascularization and multivessel (MV) revascularization in patients with acute myocardial infarction (MI) with renal insufficiency and MV disease.


METHODS
A total of 1,031 acute MI patients with renal insufficiency and MV disease who were registered in the Korea Working Group on Myocardial Infarction were enrolled. They were divided into two groups (IRA-only revascularization group, n = 404; MV revascularization group, n = 627), and investigated the cumulative incidence of major adverse cardiac events (MACE) and the incidence of complications after percutaneous coronary intervention (PCI).


RESULTS
Complications after PCI occurred in 19.9% of all patients (206/1,031). Complications after PCI occurred more frequently in the MV revascularization group compared with the IRA-only revascularization group (20.1% [126/627] vs. 15.3% [62/404], respectively; p = 0.029]. The overall in-hospital mortality rate was 6.3%, and there was no significant difference between the groups (5.2% in the IRA-only revascularization group vs. 7.0% in the MV revascularization group; p = 0.241). The total incidence of MACE was 11.1%, and there was no significant difference between the groups (11.6% in the IRA-only revascularization group vs. 10.7% in the MV revascularization group; p = 0.636).


CONCLUSIONS
The incidence of complications after PCI was significantly lower in the IRA-only revascularization group compared with the MV revascularization group. However, there were no significant difference in the 12-month outcomes between groups in patients with acute MI and renal insufficiency with MV disease.
Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital and Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea.
Hyukjin
H
Park
Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital and Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea.
Young Joon
YJ
Hong
Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital and Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea.
Si Hyun
SH
Rhew
Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital and Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea.
Sung Soo
SS
Kim
Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital and Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea.
Young Wook
YW
Jeong
Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital and Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea.
Hae Chang
HC
Jeong
Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital and Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea.
Jae Yeong
JY
Cho
Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital and Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea.
Soo Young
SY
Jang
Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital and Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea.
Ki Hong
KH
Lee
Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital and Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea.
Keun Ho
KH
Park
Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital and Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea.
Doo Sun
DS
Sim
Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital and Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea.
Nam Sik
NS
Yoon
Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital and Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea.
Hyun Ju
HJ
Yoon
Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital and Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea.
Kye Hun
KH
Kim
Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital and Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea.
Hyung Wook
HW
Park
Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital and Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea.
Ju Han
JH
Kim
Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital and Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea.
Youngkeun
Y
Ahn
Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital and Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea.
Myung Ho
MH
Jeong
Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital and Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea.
Jeong Gwan
JG
Cho
Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital and Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea.
Jong Chun
JC
Park
D000368:Aged; D000369:Aged, 80 and over; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D005260:Female; D005919:Glomerular Filtration Rate; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D011446:Prospective Studies; D012008:Recurrence; D012042:Registries; D051437:Renal Insufficiency / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D056910:Republic of Korea; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
Glomerular filtration rate; Myocardial infarction; Percutaneous coronary intervention