title: Multivessel vs culprit-only percutaneous coronary intervention among patients 65 years or older with acute myocardial infarction.
abstract: BACKGROUND
  Older adults presenting with acute myocardial infarction (MI) often have multivessel coronary artery disease amenable to percutaneous coronary intervention (PCI), yet the risks of multivessel intervention may outweigh potential benefits in these patients. We sought to determine if nonculprit intervention during the index PCI is associated with better outcomes among older patients with acute MI and multivessel disease.
  
  
  METHODS
  We examined 19,271 ST-segment elevation MI (STEMI) and 31,361 non-STEMI (NSTEMI) patients 65years or older with multivessel disease in a linked CathPCI Registry-Medicare database, excluding patients with prior coronary artery bypass grafting, left main disease, or cardiogenic shock. Using inverse probability-weighted propensity adjustment, we compared mortality between patients receiving culprit-only vs multivessel intervention during the index PCI procedure.
  
  
  RESULTS
  Most older MI patients (91% STEMI and 74% NSTEMI) received culprit-only intervention during the index PCI. Among STEMI patients, multivessel intervention during the index PCI was associated with higher 30-day mortality (8.3% vs 6.3%, adjusted hazard ratio [HR] 1.36, 95% CI 1.14-1.62) than culprit-only intervention, and this trend persisted at 1year (13.8% vs 12.2%, adjusted HR 1.14, 95% CI 0.99-1.31). No significant mortality differences were observed among NSTEMI patients at 30days (3.4% vs 4.1%, adjusted HR 1.01, 95% CI 0.88-1.15) or at 1year (10.1% vs 10.8%, adjusted HR 0.99, 95% CI 0.91-1.08).
  
  
  CONCLUSIONS
  Nonculprit intervention during the index PCI was associated with worse outcomes among STEMI patients, but not NSTEMI patients.
authors: Duke Clinical Research Institute, Durham, NC. Electronic address: tracy.wang@duke.edu.
authors: Tracy Y
authors: TY
authors: Wang
authors: Duke Clinical Research Institute, Durham, NC.
authors: Lisa A
authors: LA
authors: McCoy
authors: Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
authors: Deepak L
authors: DL
authors: Bhatt
authors: Duke Clinical Research Institute, Durham, NC.
authors: Sunil V
authors: SV
authors: Rao
authors: Duke Clinical Research Institute, Durham, NC.
authors: Matthew T
authors: MT
authors: Roe
authors: Lahey Hospital and Medical Center, Burlington, MA.
authors: Frederic S
authors: FS
authors: Resnic
authors: Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
authors: Matthew A
authors: MA
authors: Cavender
authors: University of Colorado, Denver, CO.
authors: John C
authors: JC
authors: Messenger
authors: Duke Clinical Research Institute, Durham, NC.
authors: Eric D
authors: ED
authors: Peterson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000601:surgery*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology