title: Impact of multivessel coronary artery disease on reperfusion success in patients with ST-elevation myocardial infarction: A substudy of the AIDA STEMI trial.
abstract: BACKGROUND
  A significant portion of patients with ST-elevation myocardial infarction (STEMI) display multivessel coronary artery disease. However, data on the association of multivessel coronary artery disease and reperfusion success are scarce. The aim of the current study was to analyse the impact of multivessel coronary artery disease on myocardial salvage assessed by cardiac magnetic resonance imaging in a large unselected cohort of STEMI patients.
  
  
  METHODS
  STEMI patients ( n=738) included in the AIDA STEMI trial underwent primary percutaneous coronary intervention within 12 hours after symptom onset. Cardiac magnetic resonance imaging was performed 3 days after the index event (interquartile range (IQR) 2-4). The severity of coronary artery disease was graded as single-vessel disease compared to multivessel disease. The primary endpoint was defined as a composite of death, non-fatal myocardial re-infarction and congestive heart failure (major adverse cardiac events) at 12 months.
  
  
  RESULTS
  Multivessel coronary artery disease was present in 46.3% ( n=342) of all patients. Patients with multivessel coronary artery disease were older and more often had diabetes in comparison to those with single-vessel disease ( P<0.001 and P=0.005). Angiographic and electrocardiographic reperfusion success defined as Thrombolysis in Myocardial Infarction flow III post-percutaneous coronary intervention and ST-segment resolution ⩾70% were similar between both groups ( P=0.48 and P=0.21). Patients with multivessel disease displayed no significant difference with respect to myocardial salvage index (49.8 (IQR 31.4-71.6) versus 52.7 (IQR 35.1-67.1), P=0.81) in comparison to patients with single-vessel disease. The presence of multivessel coronary artery disease was identified as an independent predictor for the time-dependent occurrence of major adverse cardiac events (hazard ratio 3.25, 95% confidence interval 1.53-6.91, P=0.002).
  
  
  CONCLUSIONS
  Although multivessel coronary artery disease is not associated with impaired reperfusion success assessed by cardiac magnetic resonance imaging, patients with multivessel disease are at a high risk of adverse clinical outcomes.
  
  
  BACKGROUND
  Clinicaltrials.gov NCT00712101.
authors.affiliation: 1 University Heart Centre Lübeck, University Hospital Schleswig-Holstein, Germany.
authors.forename: Suzanne
authors.initials: S
authors.lastname: de Waha
authors.affiliation: 1 University Heart Centre Lübeck, University Hospital Schleswig-Holstein, Germany.
authors.forename: Ingo
authors.initials: I
authors.lastname: Eitel
authors.affiliation: 1 University Heart Centre Lübeck, University Hospital Schleswig-Holstein, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Desch
authors.affiliation: 1 University Heart Centre Lübeck, University Hospital Schleswig-Holstein, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Fuernau
authors.affiliation: 1 University Heart Centre Lübeck, University Hospital Schleswig-Holstein, Germany.
authors.forename: Janine
authors.initials: J
authors.lastname: Pöss
authors.affiliation: 2 Department of Internal Medicine - Cardiology, University of Leipzig - Heart Centre, Germany.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schuler
authors.affiliation: 1 University Heart Centre Lübeck, University Hospital Schleswig-Holstein, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Thiele
mesh_terms: D000368:Aged; D002423:Cause of Death / Q000639:trends; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D004562:Electrocardiography; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D015425:Myocardial Reperfusion / Q000379:methods*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011379:Prognosis; D012008:Recurrence; D000072657:ST Elevation Myocardial Infarction / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends
keywords: ST-elevation myocardial infarction; cardiac magnetic resonance imaging; multivessel coronary artery disease; reperfusion success