TY - JOUR
T1 - Multivessel versus culprit vessel-only percutaneous coronary intervention among patients with acute myocardial infarction
T2 - Insights from the TRANSLATE-ACS observational study
AU - Ibrahim, Homam
AU - Sharma, Praneet K.
AU - Cohen, David J.
AU - Fonarow, Gregg C.
AU - Kaltenbach, Lisa A.
AU - Effron, Mark B.
AU - Zettler, Marjorie E.
AU - Peterson, Eric D.
AU - Wang, Tracy Y.
N1 - Funding Information:
Dr Cohen reports research grant support from Eli Lilly, Daiichi Sankyo, and AstraZeneca (all significant); honoraria from Eli Lilly and AstraZeneca (both modest); and consultant/advisory board for Eli Lilly and AstraZeneca (both significant). Dr Fonarow reports consultant/advisory board for Medtronic, Amgen, Janssen, Bayer, and Boston Scientific (all modest), and Novartis (significant); other for Abbott (modest); and research grant support from the National Institutes of Health, Patient-Centered Outcomes Research Institute, and Agency for Healthcare Research and Quality (all significant). Dr Effron reports being a shareholder and retiree/former employee of Eli Lilly. Dr Zettler reports shareholding with Eli Lilly. Dr Peterson reports grant support from the American College of Cardiology, American Heart Association, and Janssen; and consulting from Bayer, Boehringer Ingelheim, Merck, Valeant, Sanofi, Astra Zeneca, Janssen, Regeneron, and Genentech. Dr Wang received research grants to the Duke Clinical Research Institute from AstraZeneca, Boston Scientific, Bristol Myers Squibb, Daiichi Sankyo, Eli Lilly, Gilead Sciences, Glaxo Smith Kline, and Regeneron Pharmaceuticals; and consulting honoraria from Astra Zeneca, Eli Lilly, Merck, and Pfizer. The remaining authors have no disclosures to report.
Publisher Copyright:
© 2017 The Authors.
PY - 2017/10/1
Y1 - 2017/10/1
N2 - Background--Among patients with acute myocardial infarction (MI) who have multivessel disease, it is unclear if multivessel percutaneous coronary intervention (PCI) improves clinical and quality-of-life outcomes compared with culprit-only intervention. We sought to compare clinical and quality-of-life outcomes between multivessel and culprit-only PCI. Methods and Results--Among 6061 patients with acute MI who have multivessel disease in the TRANSLATE-ACS (Treatment With Adenosine Diphosphate Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome) study, we used inverse probability-weighted propensity adjustment to study the associations between multivessel and culprit-only intervention during the index PCI and major adverse cardiovascular events, unplanned all-cause readmission, and angina frequency at 6 weeks and 1 year. Multivessel PCI was performed in 1208 (20%) of patients with MI who had multivessel disease. Relative to the culprit-only intervention, patients receiving multivessel PCI were similarly aged and more likely to be seen with non-ST-segment elevation MI or cardiogenic shock. At 6 weeks, the initial multivessel PCI strategy was associated with lower major adverse cardiovascular events and unplanned readmission risks, whereas angina frequency was not significantly different between multivessel and culprit-only PCI. At 1 year, major adverse cardiovascular event risk was persistently lower in the multivessel PCI group (adjusted hazard ratio, 0.84; 95% confidence interval, 0.72-0.99), whereas long-term readmission risk (adjusted hazard ratio, 0.94; 95% confidence interval, 0.84-1.04) and angina frequency were similar between groups (adjusted odds ratio, 1.01; 95% confidence interval, 0.82-1.24). Similar associations were seen when patients with ST-segment elevation MI and non-ST-segment elevation MI were examined separately. Conclusions--Among patients with acute MI who have multivessel disease, multivessel PCI was associated with lower risk of all-cause readmission at 6 weeks and lower risk of major adverse cardiovascular events at 6 weeks and 1 year. However, similar short- and long-term angina frequencies were noted.
AB - Background--Among patients with acute myocardial infarction (MI) who have multivessel disease, it is unclear if multivessel percutaneous coronary intervention (PCI) improves clinical and quality-of-life outcomes compared with culprit-only intervention. We sought to compare clinical and quality-of-life outcomes between multivessel and culprit-only PCI. Methods and Results--Among 6061 patients with acute MI who have multivessel disease in the TRANSLATE-ACS (Treatment With Adenosine Diphosphate Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome) study, we used inverse probability-weighted propensity adjustment to study the associations between multivessel and culprit-only intervention during the index PCI and major adverse cardiovascular events, unplanned all-cause readmission, and angina frequency at 6 weeks and 1 year. Multivessel PCI was performed in 1208 (20%) of patients with MI who had multivessel disease. Relative to the culprit-only intervention, patients receiving multivessel PCI were similarly aged and more likely to be seen with non-ST-segment elevation MI or cardiogenic shock. At 6 weeks, the initial multivessel PCI strategy was associated with lower major adverse cardiovascular events and unplanned readmission risks, whereas angina frequency was not significantly different between multivessel and culprit-only PCI. At 1 year, major adverse cardiovascular event risk was persistently lower in the multivessel PCI group (adjusted hazard ratio, 0.84; 95% confidence interval, 0.72-0.99), whereas long-term readmission risk (adjusted hazard ratio, 0.94; 95% confidence interval, 0.84-1.04) and angina frequency were similar between groups (adjusted odds ratio, 1.01; 95% confidence interval, 0.82-1.24). Similar associations were seen when patients with ST-segment elevation MI and non-ST-segment elevation MI were examined separately. Conclusions--Among patients with acute MI who have multivessel disease, multivessel PCI was associated with lower risk of all-cause readmission at 6 weeks and lower risk of major adverse cardiovascular events at 6 weeks and 1 year. However, similar short- and long-term angina frequencies were noted.
KW - Culprit artery
KW - Multivessel coronary artery disease
KW - Multivessel percutaneous coronary intervention
KW - Quality of life
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U2 - 10.1161/JAHA.117.006343
DO - 10.1161/JAHA.117.006343
M3 - Article
C2 - 28982673
AN - SCOPUS:85032216861
VL - 6
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
SN - 2047-9980
IS - 10
M1 - e006343
ER -