Coronary artery disease
Prevalence, Predictors, and In-Hospital Outcomes of Non-Infarct Artery Intervention During Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction (from the National Cardiovascular Data Registry)

https://doi.org/10.1016/j.amjcard.2009.04.016Get rights and content

Guidelines support percutaneous coronary intervention (PCI) of the noninfarct-related artery during primary PCI for ST-segment elevation myocardial infarction (STEMI) in patients with hemodynamic compromise; however, in patients without hemodynamic compromise, PCI of the noninfarct-related artery is given a class III recommendation. We analyzed the National Cardiovascular Data Registry (n = 708,481 admissions, 638 sites) to determine the prevalence, predictors, and in-hospital outcomes of primary multivessel PCI from 2004 to 2007. Patients with STEMI and multivessel coronary artery disease who were undergoing primary PCI were identified (n = 31,681). After excluding the patients treated with staged PCI (n = 2,745), 10.8% (n = 3,134) of the remaining population (n = 28,936) were treated with multivessel PCI. Patients undergoing multivessel PCI were at higher risk and were more likely to be in cardiogenic shock. The overall in-hospital mortality rates were greater in patients undergoing multivessel PCI (7.9% vs 5.1%, p <0.01). Among patients with STEMI and cardiogenic shock (n = 3,087), those receiving multivessel PCI had greater in-hospital mortality (36.5% vs 27.8%; adjusted odds ratio 1.54, 95% confidence interval 1.22 to 1.95). In conclusion, these data suggest that performing multivessel PCI during primary PCI for STEMI does not improve short-term survival even for patients with cardiogenic shock. These findings suggest the need for definitive studies to evaluate the utility of noninfarct-related artery PCI among patients with STEMI.

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Methods

The NCDR, which is co-sponsored by the American College of Cardiology and the Society for Cardiac Angiography and Interventions, has been previously described.7, 8 The NCDR catalogs the clinical data and outcomes of PCI procedures gathered from >600 sites across the United States. The data are entered into NCDR-certified databases at participating institutions and exported in a standard format to a common database at Heart House (Washington, DC). Only institutions whose submissions have met the

Results

A total of 708,481 admissions from 638 sites were entered into the NCDR from 2004 to 2007. We identified 31,681 patients undergoing primary PCI for STEMI who had multivessel coronary artery disease. Of these patients, 8.7% (n = 2,745) underwent staged PCI and were excluded from the analysis, leaving 28,936 patient encounters included in the analysis. Of these, 10.8% (n = 3,134) were treated with multivessel PCI.

Patients who underwent multivessel PCI had a lower incidence of previously

Discussion

Our analysis of a large contemporary PCI database has shown that multivessel coronary interventions during primary PCI for STEMI occurs in ≤10% of PCI cases in clinical practice; however, its use varied considerably among centers. Although no consistency was found in its use, we did find that multivessel PCI in the setting of primary PCI was associated with worse outcomes. Among patients with STEMI without hemodynamic compromise, multivessel PCI did not improve in-hospital outcomes, supporting

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This analysis was supported by a grant from the American College of Cardiology, Washington, DC, and the Society for Cardiac Angiography and Interventions, Washington, DC.

This analysis was supported by the National Cardiovascular Data Registry.

Dr. Roe was supported by research grants from Schering Plough, BMS/Sanofi-Aventis, KAI Pharmaceuticals, and DeCODE Genetics; is on the consulting/advisory boards for Schering Plough, KAI Pharmaceuticals; and is on the Speakers Bureau or has received honoraria from Schering Plough and BMS/Sanofi-Aventis.

Dr. Peterson has received research grants from Bristol-Myers Squibb, Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership, Bristol-Myers Squibb/Merck, and Schering (additional disclosure information for Dr. Peterson is available from: http://dcri.org/research/coi.jsp).

Dr. Rao is a Consultant for Sanofi-Aventis and member of the Speakers' Bureaus for Sanofi-Aventis, Bristol Myers Squibb, and the Medicines Company and has received research funding from Momenta Pharmaceuticals, Portola Pharmaceuticals, and Cordis.

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