title: Is multivessel intervention in ST-elevation myocardial infarction associated with early harm? Insights from observational data.
abstract: OBJECTIVE
  Appraisal of evidence for recommendations for multivessel coronary intervention in ST-elevation myocardial infarction (STEMI).
  
  
  BACKGROUND
  Multi-vessel disease (MVD) is common in patients with ST-segment elevation myocardial infarction (STEMI). Published observational data has suggested that multi-vessel percutaneous coronary intervention (MVPCI) at the time of initial hospitalization for STEMI may be harmful in contrast to evidence from recent randomized trials.
  
  
  METHODS
  We queried the nationwide inpatient sample (NIS) to identify characteristics of hemodynamically stable STEMI patients undergoing MVPCI on index admission and subsequent mortality in raw and adjusted models. To compare our results with published observational data, we searched multiple databases from inception through July 15, 2015.
  
  
  RESULTS
  From 2009-2012, excluding cardiac arrest or cardiogenic shock, there were 11,454 MVPCI and 157,011 single-vessel PCI (SVPCI) for STEMI patients in the NIS. Compared to SVPCI, MVPCI on index admission was not associated with higher in-hospital mortality in unadjusted or propensity-adjusted models (MVPCI 1.91% vs. SVPCI 5.32%, P < 0.001). Our analysis of index hospitalization MVPCI versus infarct-related artery (IRA)-only PCI in the meta-analysis of observational studies (19 studies, N = 76,399) demonstrated no difference in in-hospital mortality with MVPCI compared with IRA-only PCI (OR 0.87, 95% CI 0.65-1.17; P = 0.37), with confirmation in study sequential analysis.
  
  
  CONCLUSIONS
  MVPCI is uncommonly performed during index hospitalization in hemodynamically stable STEMI patients, likely reflecting widespread adherence to prior guidelines. Based on observational data, there does not appear to be early harm associated with MVPCI on the index admission in hemodynamically stable STEMI patients. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Division of Cardiology, St. Lukes-Roosevelt Hospitals of the Mount Sinai Health System, New York, New York.
authors.forename: Saurav
authors.initials: S
authors.lastname: Chatterjee
authors.affiliation: Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Yeh
authors.affiliation: Division of Cardiology, University of Utah, Salt Lake City, Utah.
authors.forename: Partha
authors.initials: P
authors.lastname: Sardar
authors.affiliation: Division of Cardiology, St. Lukes-Roosevelt Hospitals of the Mount Sinai Health System, New York, New York.
authors.forename: Hafeez
authors.initials: H
authors.lastname: Ul Hassan Virk
authors.affiliation: Division of Cardiology, Texas Tech University, El Paso, Texas.
authors.forename: Debabrata
authors.initials: D
authors.lastname: Mukherjee
authors.affiliation: Cardiovascular Medicine Division, University Hospitals Case Medical Center, Harrington Heart and Vascular Institute and Case Western Reserve University School of Medicine, Cleveland, Ohio.
authors.forename: Sahil A
authors.initials: SA
authors.lastname: Parikh
authors.affiliation: Division of Cardiology, University of Texas Southwestern Medical School, Dallas, Texas.
authors.forename: Dharam J
authors.initials: DJ
authors.lastname: Kumbhani
authors.affiliation: Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center at Columbia University Medical Center/New York-Presbyterian Hospital, New York, New York.
authors.forename: Ajay
authors.initials: A
authors.lastname: Kirtane
authors.affiliation: Division of Cardiology, Temple University School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Riyaz
authors.initials: R
authors.lastname: Bashir
authors.affiliation: Division of Cardiology, Temple University School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Howard
authors.initials: H
authors.lastname: Cohen
authors.affiliation: Cardiovascular Medicine Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Kolansky
authors.affiliation: Cardiovascular Medicine Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Wilensky
authors.affiliation: Cardiovascular Medicine Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Jay
authors.initials: J
authors.lastname: Giri
mesh_terms: D017023:Coronary Angiography; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis / Q000601:surgery*
keywords: acute myocardial infarction; multi-vessel disease; percutaneous coronary intervention