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

Roberto A. Corpus, John A. House, Steven P. Marso, J. Aaron Grantham, Kenneth C. Huber, Steven B. Laster, Warren L. Johnson, William C. Daniels, Charles W. Barth, Lee V. Giorgi, Barry D. Rutherford

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176 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)493-500
Number of pages8
JournalAmerican Heart Journal
Volume148
Issue number3
DOIs
StatePublished - Sep 1 2004

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Corpus, R. A., House, J. A., Marso, S. P., Grantham, J. A., Huber, K. C., Laster, S. B., Johnson, W. L., Daniels, W. C., Barth, C. W., Giorgi, L. V., & Rutherford, B. D. (2004). Multivessel percutaneous coronary intervention in patients with multivessel disease and acute myocardial infarction. American Heart Journal, 148(3), 493-500. https://doi.org/10.1016/j.ahj.2004.03.051