Benefit of Revascularization in Non-Infarct-Related Artery in Multivessel Disease Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Abstract

SummaryThis study compared the prognosis of ST-elevation myocardial infarction (STEMI) in patients with multivessel disease (MVD) with that of single vessel disease (SVD) and investigated the revascularization benefit of noninfarct-related artery (IRA) in MVD patients undergoing primary percutaneous coronary intervention (PCI). Between 2002 and 2009, 1278 patients with STEMI underwent primary PCI. Of these patients, 717 (56.1%) with SVD (only IRA obstruction) were placed in group A, while 561 (43.9%) with MVD (Group B) were further categorized into group 1 (PCI for IRA) and group 2 (staged PCI for IRA+non-IRA). The results demonstrated a lower degree of successful reperfusion in IRA and higher 30-day and 1-year cumulative mortality rates in group B (P < 0.001). While there was no difference in successful reperfusion in IRA between group 1 and group 2, the 30-day and one-year cumulative mortality rates were higher in group 1. Multivariate analysis identified MVD as an independent predictor of 1-year mortality (P < 0.001). In conclusion, patients with subsequent PCI for MVD had better 30-day and 1-year outcomes than those with conservative treatment. (Int Heart J 2010; 51: 319-324)

Value and Level of Galectin-3 in Acute Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention

“…The creatinine level 30,32) , LVEF 7, 12) and multiple vessel disease 33) are three traditional risk factors for predicting an unfavorable clinical outcome after AMI and the present study confirmed that these three traditional risk factors were also significant independent predictors of 30-day MACO in patients with STEMI undergoing primary PCI. In addition to traditional risk factors, many biomarkers have been linked to unfavorable clinical outcomes [10][11][12][13][14] of AMI-induced CHF.…”

Staged versus One-Time Complete Revascularization with Percutaneous Coronary Intervention in STEMI Patients with Multivessel Disease: A Systematic Review and Meta-Analysis

“…However, multivessel disease in STEMI patients continues to pose a major challenge and has been associated with substantially worse prognosis compared with single-vessel disease [4,6,7]. Earlier clinical practice guidelines recommend that in STEMI patients, only the culprit vessel be initially treated, unless hemodynamic compromise is present [13,14].…”

“…Approximately 40–50% of patients with STEMI have at least 1 additional severe stenosis lesion of >50% in the non-culprit vessel [4,5]. Patients with multivessel disease (MVD) have worse clinical outcomes in terms of major adverse cardiovascular events (mortality, reinfarction, and target-vessel revascularization) than patients with single-vessel disease [4,6,7]. One-time, multivessel PCI may contribute to a higher risk of complications such as stent thrombosis [8–10], inflammatory burden [11], and contrast-induced nephropathy [12] associated with STEMI.…”

Timing of Staged Percutaneous Coronary Intervention for a Non-Culprit Lesion in Patients With Anterior Wall ST Segment Elevation Myocardial Infarction With Multiple Vessel Disease

“…12) One observational study showed a higher 30-day mortality and one-year mortality in early-staged PCI (the time of staged PCI within one month after primary PCI) when compared to late-staged PCI (the time of staged PCI more than one month and less than 6 months after primary PCI). 13) To the best of our knowledge, no studies have discussed the timing of staged PCI in different territories of STE-MI.…”