Elsevier

American Heart Journal

Volume 148, Issue 3, September 2004, Pages 493-500
American Heart Journal

Clinical investigation
Multivessel percutaneous coronary intervention in patients with multivessel disease and acute myocardial infarction

https://doi.org/10.1016/j.ahj.2004.03.051Get rights and content

Abstract

Background

The optimal percutaneous interventional strategy for dealing with significant non-culprit lesions in patients with multivessel disease (MVD) with acute myocardial infarction (AMI) at presentation remains controversial.

Methods

A total of 820 patients treated with primary angioplasty for AMI between 1998 and 2002 were classified in groups of patients with single vessel disease (SVD) or MVD (≥70% stenosis of ≥2 coronary arteries). Patients with MVD were subdivided in 3 groups on the basis of the revascularization strategy: 1) patients undergoing percutaneous coronary intervention (PCI) of the infarct-related artery (IRA) only; 2) patients undergoing PCI of both the IRA and non-IRA(s) during the initial procedure; and 3) patients undergoing PCI of the IRA followed by staged, in-hospital PCI of the non-IRA(s). Procedural, 30-day, and 1-year outcomes are reported.

Results

At 1 year, compared with patients with SVD, patients with MVD had a higher incidence of re-infarction (5.9% vs 1.6%, P = .003), revascularization (18% vs 9.6%, P <.001), mortality (12% vs 3.2%, P <.001), and major adverse cardiac events (MACEs; 31% vs 13%, P <.001). In patients with MVD, compared with PCI restricted to the IRA only, multivessel PCI was associated with higher rates of re-infarction (13.0% vs 2.8%, P <.001), revascularization (25% vs 15%, P = .007), and MACEs (40% vs 28%, P = .006). Multivessel PCI was an independent predictor of MACEs at 1 year (odds ratio = 1.67, P = .01).

Conclusions

These data suggest that in patients with MVD, PCI should be directed at the IRA only, with decisions about PCI of non-culprit lesions guided by objective evidence of residual ischemia at late follow-up. Further studies are needed to confirm these findings.

Section snippets

Study patients

Between 1998 and 2002, 820 patients with AMI were treated with primary PCI. Patients were stratified according to the presence or absence of MVD, which was defined as ≥70% stenosis of ≥2 epicardial coronary arteries or their major branches. Patients with MVD were further classified according to the strategy used for revascularization. Patients in the IRA-only group had only the infarct-related vessel treated, whereas patients in the multivessel PCI group had both the infarct-related and

Results

From January 1998 to January 2002, 820 consecutive patients meeting the entry criteria for this study underwent primary coronary angioplasty for AMI at our institution. Of these patients, 314 (38%) had single-vessel disease (SVD) and 506 (62%) had MVD. Of the patients with MVD, 354 underwent PCI restricted to the IRA only, whereas 152 underwent multivessel PCI, either during the same procedure (N = 26) or in a staged fashion during the index hospitalization (N = 126) (Figure 2).

Discussion

MVD occurs in between 40% and 65% of patients with AMI at presentation1, 2, 3 and confers an increased risk of morbidity and mortality after reperfusion therapy.1, 4, 5 In the setting of AMI, percutaneous revascularization of the culprit lesion is efficacious;6, 7, 8 however, treatment of non-culprit lesions in patients with MVD remains controversial. This study demonstrates that in patients with MVD and AMI, multivessel PCI is technically feasible, but is associated with higher post-procedural

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