Long-term impact of multivessel disease on cause-specific mortality after ST elevation myocardial infarction treated with reperfusion therapy

Schaaf, René J. van der; Timmer, Jorik R.; Ottervanger, Jan Paul; Hoorntje, Jan C.A.; Boer, M-J de; Suryapranata, Harry; Zijlstra, Felix; Dambrink, J-H E

doi:10.1136/hrt.2005.086058

Cited by 72 publications

(40 citation statements)

References 23 publications

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“…13) Although there are several studies regarding AMI with multivessel disease, 2,3,14) there have only been a few studies focusing on AMI with TVD. The mortality rate was greater in the present study (10.9%) as compared to earlier studies regarding AMI with multivessel disease 2,3) because our study did not exclude the highest mortality group such as CPA on arrival.…”

Section: Discussionmentioning

confidence: 99%

Determinants of In-Hospital Death in Acute Myocardial Infarction With Triple Vessel Disease

et al. 2016

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SummaryCompared to acute myocardial infarction (AMI) with single vessel disease (SVD) or double vessel disease (DVD), AMI with triple vessel disease (TVD) is associated with higher mortality. The aim of this study was to identify the determinants of in-hospital death in AMI with TVD. We identified AMI patients with TVD in our tertiary medical center between January 2009 and December 2014. Baseline patient characteristics including laboratory data, echocardiograms, and coronary angiograms were collected from our hospital records. We divided our study population into a survivor group and non-survivor group. Multivariate stepwise logistic regression analysis was performed to identify the determinants of in-hospital death. A total of 138 AMI patients with TVD were identified and included as the final study population. Fifteen patients died during the hospitalization (mortality rate, 10.9%). Mean systolic blood pressure (134 ± 27 mmHg) was significantly greater in the survivor group compared with the non-survivor group (114 ± 31 mmHg) (P = 0.02). The prevalence of shock on admission was significantly less in the survivor group (15.4%) than in the non-survivor group (66.7%) (P < 0.001). Multivariate stepwise logistic regression analysis revealed that shock status on admission (OR 11.50, 95% CI 3.21-41.14, P < 0.001), the left anterior descending artery (LAD) as the infarct related artery (IRA) (OR 3.83, 95% CI 1.04-14.09, P = 0.04), and serum albumin on admission (OR 0.26, 95% CI 0.08-0.84, P = 0.02) were significantly associated with in-hospital death. In conclusion, shock status on admission, the LAD as the IRA, and a low serum albumin level were the determinants of in-hospital death in AMI patients with TVD. ( 1,2) The in-hospital mortality rates of AMI complicated with cardiogenic shock with SVD, DVD, and TVD were reported to be 32.8%, 45.1%, and 58.2%, respectively. 1) Furthermore, the long-term mortality of AMI with TVD is poorer than that with DVD.2) Although several groups studied the determinants of poor clinical outcomes in AMI with multivessel disease, 3,4) the determinants of in-hospital death in AMI with TVD have not been fully investigated. It is clinically important to identify such determinants in order to obtain a better understanding of AMI with TVD, because the mortality of AMI with TVD is the greatest among AMI.

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Section: Discussionmentioning

confidence: 99%

Determinants of In-Hospital Death in Acute Myocardial Infarction With Triple Vessel Disease

et al. 2016

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“…92,93 The current ACCF/AHA guidelines recommend against revascularization of the noninfarct-related arteries at the time of the index primary PCI procedure except in patients with hemodynamic instability. 18 A recent systematic review and metaanalysis showed that worse clinical outcomes associated with performing PCI of noninfarct-related stenosis during the index primary PCI procedure have been observed in nonrandomized cohort studies but not in the small number of randomized controlled trials.…”

Section: Revascularization Of Noninfarct Stenosis During Primary Pcimentioning

confidence: 99%

Reperfusion Strategies in Acute Coronary Syndromes

Bagai

Dangas

Stone

et al. 2014

Circulation Research

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The appropriate timing of angiography to facilitate revascularization is essential to optimize outcomes in patents with ST-segment–elevation myocardial infarction and non–ST-segment–elevation acute coronary syndromes. Timely reperfusion of the infarct-related coronary artery in ST-segment–elevation myocardial infarction both with fibrinolysis or percutaneous coronary intervention minimizes myocardial damage, reduces infarct size, and decreases morbidity and mortality. Primary percutaneous coronary intervention is the preferred reperfusion method if it can be performed in a timely manner. Strategies to reduce health system–related delays in reperfusion include regionalization of ST-segment–elevation myocardial infarction care, performing prehospital ECGs, prehospital activation of the catheterization laboratory, bypassing geographically closer nonpercutaneous coronary intervention–capable hospitals, bypassing the percutaneous coronary intervention–capable hospital emergency department, and early and consistent availability of the catheterization laboratory team. With implementation of such strategies, there has been significant improvement in process measures, including door-to-balloon time. However, despite reductions in door-to-balloon times, there has been little change during the past several years in in-hospital mortality, suggesting additional factors including patient-related delays, optimization of tissue-level perfusion, and cardioprotection must be addressed to improve patient outcomes further. Early angiography followed by revascularization when appropriate also reduces rates of death, MI, and recurrent ischemia in patients with non–ST-segment–elevation acute coronary syndromes, with the greatest benefits realized in the highest risk patients. Among patients with non–ST-segment–elevation acute coronary syndromes with multivessel disease, choice of revascularization modality should be made as in stable coronary artery disease, with a goal of complete ischemic revascularization.

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“…Successful and timely primary PCI leads to salvage of myocardium at risk and reduces mortality (1). Angiography before primary PCI has shown that multivessel coronary artery disease (MVD) is present in 40% to 65% of patients with STEMI and is associated with higher morbidity and mortality after reperfusion therapy (2)(3)(4)(5). A concurrent chronic total occlusion (CTO) in a non-IRA is present in 12% to 13% of patients with STEMI (2,4).…”

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confidence: 99%

Evaluation of the Effect of a Concurrent Chronic Total Occlusion on Long-Term Mortality and Left Ventricular Function in Patients After Primary Percutaneous Coronary Intervention

Claessen

Schaaf

Verouden

et al. 2009

JACC: Cardiovascular Interventions

223

123

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Long-term impact of multivessel disease on cause-specific mortality after ST elevation myocardial infarction treated with reperfusion therapy

Cited by 72 publications

References 23 publications

Determinants of In-Hospital Death in Acute Myocardial Infarction With Triple Vessel Disease

Determinants of In-Hospital Death in Acute Myocardial Infarction With Triple Vessel Disease

Reperfusion Strategies in Acute Coronary Syndromes

Evaluation of the Effect of a Concurrent Chronic Total Occlusion on Long-Term Mortality and Left Ventricular Function in Patients After Primary Percutaneous Coronary Intervention

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