Complete or incomplete coronary revascularisation in patients with myocardial infarction and multivessel disease: a propensity score analysis from the "real-life" BleeMACS (Bleeding complications in a Multicenter registry of patients discharged with diagnosis of Acute Coronary Syndrome) registry.
OBJECTIVE
The benefit of complete or incomplete percutaneous coronary intervention (PCI) in patients with myocardial infarction and multivessel disease remains debated. The aim of our study was to compare a complete vs. a "culprit only" revascularisation strategy in patients with myocardial infarction distinguishing the different clinical subsets (STEMI and NSTEMI) and to provide one-year clinical outcome from the "real-life" BleeMACS (Bleeding complications in a Multicenter registry of patients discharged with diagnosis of Acute Coronary Syndrome) registry.


RESULTS
We conducted a multicentre study including all patients with myocardial infarction and multivessel coronary disease included in the BleeMACS (Bleeding complications in a Multicenter registry of patients discharged with diagnosis of Acute Coronary Syndrome) registry. They were divided into two groups, complete revascularisation (CR) and incomplete revascularisation (IR). The primary endpoint was the death rate at one-year follow-up. Secondary endpoints were in-hospital repeat myocardial infarction (re-AMI), in-hospital heart failure (HF), major adverse cardiovascular events (MACE) and myocardial infarction at one year. Four thousand five hundred and twenty patients were included in our analysis, with a diagnosis of STEMI in 67.7% and NSTEMI in 32.3%. CR was performed in 27.2% and 42.4%, respectively. At univariate analysis, in-hospital and one-year outcomes were similar between CR and IR in STEMI patients (all p-values >0.05). In NSTEMI patients, CR was associated with a lower one-year death rate (4.5% vs. 8.5%; p=0.002), re-AMI (3.7% vs. 6.6%; p=0.016) and MACE (8.1% vs. 13.9%; p=0.001). After propensity score matching, CR also reduced events in STEMI patients, including one-year mortality (5.3% vs. 13.8%; p<0.001), re-AMI (4.9% vs. 17.4%; p<0.001) and MACE (8.5% vs. 24.6%; p<0.001).


CONCLUSIONS
This multicentre retrospective registry showed the benefit of CR in terms of reduction of one-year mortality in patients with myocardial reinfarction and multivessel coronary disease. Randomised controlled trials including functional evaluation of the lesions should be performed to confirm our results.
Dipartimento di Scienze Mediche, Divisione di Cardiologia, Città della Salute e della Scienza, Turin, Italy.
Giorgio
G
Quadri
Fabrizio
F
D'Ascenzo
Claudio
C
Moretti
Maurizio
M
D'Amico
Sergio
S
Raposeiras-Roubín
Emad
E
Abu-Assi
Jose Paulo Simao
JPS
Henriques
Jorge
J
Saucedo
José Ramón
JR
González-Juanatey
Stephen B
SB
Wilton
Wouter J
WJ
Kikkert
Iván
I
Nuñez-Gil
Albert
A
Ariza-Sole
Xiantao
X
Song
Dimitrios
D
Alexopoulos
Christoph
C
Liebetrau
Tetsuma
T
Kawaji
Zenon
Z
Huczek
Shao-Ping
SP
Nie
Toshiharu
T
Fujii
Luis
L
Correia
Masa-Aki
MA
Kawashiri
José María
JM
García-Acuña
Danielle
D
Southern
Emilio
E
Alfonso
Belén
B
Terol
Alberto
A
Garay
Dongfeng
D
Zhang
Yalei
Y
Chen
Ioanna
I
Xanthopoulou
Neriman
N
Osman
Helge
H
Möllmann
Hiroki
H
Shiomi
Pierluigi
P
Omedè
Antonio
A
Montefusco
Francesca
F
Giordana
Silvia
S
Scarano
Michal
M
Kowara
Krzysztof
K
Filipiak
Xiao
X
Wang
Yan
Y
Yan
Jing-Yao
JY
Fan
Yuji
Y
Ikari
Takuya
T
Nakahashi
Kenji
K
Sakata
Masakazu
M
Yamagishi
Oliver
O
Kalpak
Sasko
S
Kedev
Ferdinando
F
Varbella
Fiorenzo
F
Gaita
D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000601:surgery*; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D003324:Coronary Artery Disease / Q000601:surgery*; D003331:Coronary Vessels / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D009203:Myocardial Infarction / Q000601:surgery*; D009204:Myocardial Revascularization / Q000379:methods; D012008:Recurrence; D012042:Registries