title: Impact of multivessel revascularization on health status outcomes in patients with ST-segment elevation myocardial infarction and multivessel coronary artery disease.
abstract: BACKGROUND
  Up to 65% of patients with ST-segment elevation myocardial infarction (STEMI) have multivessel coronary artery disease (MVCAD). Long-term health status of STEMI patients after multivessel revascularization is unknown.
  
  
  OBJECTIVE
  This study investigated the relationship between multivessel revascularization and health status outcomes (symptoms and quality of life [QoL]) in STEMI patients with MVCAD.
  
  
  METHODS
  Using a U.S. myocardial infarction registry and the Seattle Angina Questionnaire (SAQ), we determined the health status of patients with STEMI and MVCAD at the time of STEMI and 1 year later. We assessed the association of multivessel revascularization during index hospitalization with 1-year health status using multivariable linear regression analysis, and also examined demographic, clinical, and angiographic factors associated with multivessel revascularization.
  
  
  RESULTS
  Among 664 STEMI patients with MVCAD, 251 (38%) underwent multivessel revascularization. Most revascularizations were staged during the index hospitalization (64.1%), and 8.0% were staged after discharge, with 27.9% performed during primary percutaneous coronary intervention. Multivessel revascularization was associated with age and more diseased vessels. At 1 year, multivessel revascularization was independently associated with improved symptoms (4.5 points higher SAQ angina frequency score; 95% confidence interval [CI]: 1.0 to 7.9) and QoL (6.6 points higher SAQ QoL score; 95% CI: 2.7 to 10.6). One-year mortality was not different between those who did and did not undergo multivessel revascularization (3.6% vs. 3.4%; log-rank test p = 0.88).
  
  
  CONCLUSIONS
  Multivessel revascularization improved angina and QoL in STEMI patients with MVCAD. Patient-centered outcomes should be considered in future trials of multivessel revascularization.
authors.affiliation: Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri; University of Missouri-Kansas City, Kansas City, Missouri; Department of Cardiology, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.
authors.forename: Jae-Sik
authors.initials: JS
authors.lastname: Jang
authors.affiliation: Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri; University of Missouri-Kansas City, Kansas City, Missouri. Electronic address: spertusj@umkc.edu.
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
authors.affiliation: Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri; University of Missouri-Kansas City, Kansas City, Missouri.
authors.forename: Suzanne V
authors.initials: SV
authors.lastname: Arnold
authors.affiliation: Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri; University of Missouri-Kansas City, Kansas City, Missouri.
authors.forename: Ali
authors.initials: A
authors.lastname: Shafiq
authors.affiliation: Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri; University of Missouri-Kansas City, Kansas City, Missouri.
authors.forename: Anna
authors.initials: A
authors.lastname: Grodzinsky
authors.affiliation: Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri; University of Missouri-Kansas City, Kansas City, Missouri.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Fendler
authors.affiliation: Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri; University of Missouri-Kansas City, Kansas City, Missouri.
authors.forename: Adam C
authors.initials: AC
authors.lastname: Salisbury
authors.affiliation: Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri.
authors.forename: Fengming
authors.initials: F
authors.lastname: Tang
authors.affiliation: Division of Cardiology, Kaiser Permanente Medical Center, San Francisco, California.
authors.forename: Edward J
authors.initials: EJ
authors.lastname: McNulty
authors.affiliation: Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri; University of Missouri-Kansas City, Kansas City, Missouri.
authors.forename: J Aaron
authors.initials: JA
authors.lastname: Grantham
authors.affiliation: Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri; University of Missouri-Kansas City, Kansas City, Missouri.
authors.forename: David J
authors.initials: DJ
authors.lastname: Cohen
authors.affiliation: Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri; Barnes-Jewish Hospital, St. Louis, Missouri.
authors.forename: Amit P
authors.initials: AP
authors.lastname: Amin
mesh_terms: D003324:Coronary Artery Disease / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D009204:Myocardial Revascularization / Q000379:methods*; D011446:Prospective Studies; D012042:Registries; D016896:Treatment Outcome
keywords: myocardial infarction; percutaneous coronary intervention; quality of health care