Outcomes of Different Reperfusion Strategies of Multivessel Disease Undergoing Newer-Generation Drug-Eluting Stent Implantation in Patients with Non-ST-Elevation Myocardial Infarction and Chronic Kidney Disease

Abstract

Because available data are limited, we compared the 2-year clinical outcomes among different reperfusion strategies (culprit-only percutaneous coronary intervention (C-PCI), multivessel PCI (M-PCI), complete revascularization (CR) and incomplete revascularization (IR)) of multivessel disease (MVD) undergoing newer-generation drug-eluting stent implantation in patients with non-ST-elevation myocardial infarction (NSTEMI) and chronic kidney disease (CKD). In this nonrandomized, multicenter, retrospective cohort study, a total of 1042 patients (C-PCI, n = 470; M-PCI, n = 572; CR, n = 432; IR, n = 140) were recruited from the Korea Acute Myocardial Infarction Registry (KAMIR) and evaluated. The primary outcome was the occurrence of major adverse cardiac events, defined as all-cause death, recurrent myocardial infarction and any repeat coronary revascularization. The secondary outcome was probable or definite stent thrombosis. During the 2-year follow-up period, the cumulative incidences of the primary (C-PCI vs. M-PCI, adjusted hazard ratio (aHR), 1.020; p = 0.924; CR vs. IR, aHR, 1.012; p = 0.967; C-PCI vs. CR, aHR, 1.042; p = 0.863; or C-PCI vs. IR, aHR, 1.060; p = 0.844) and secondary outcomes were statistically insignificant in the four comparison groups. In the contemporary newer-generation DES era, C-PCI may be a better reperfusion option for patients with NSTEMI with MVD and CKD rather than M-PCI, including CR and IR, with regard to the procedure time and the risk of contrast-induced nephropathy. However, further well-designed, large-scale randomized studies are warranted to confirm these results.

The management of non‐culprit vessel(s) in patients with unstable angina/non‐ST elevation myocardial infarction and chronic kidney dysfunction

“…Due to comorbid conditions and increased periprocedural events, managing the multivessel lesions in patients with CKD is more complicated. 10 In contrast to a prior Korean retrospective cohort study that found MV-PCI failed to reduce death during a 24-month follow-up period, 22 our results supported the use of MV-PCI among UA/NSTEMI and CKD. The inconsistency could likely be attributed to heterogeneities in the patients enrolled and study methods.…”

Effect of delayed hospitalization on 3-year clinical outcomes according to renal function in patients with non-ST-segment elevation myocardial infarction

“…In a recent publication [ 35 ], consistent with previous reports [ 33 , 34 ], the 2-year major clinical outcomes were similar between the early invasive and delayed invasive groups in patients with NSTEMI (n = 8241) in the four different renal function groups. Kim et al [ 37 ] also suggested that culprit-only PCI may be a better reperfusion option for patients with NSTEMI with multivessel disease and CKD rather than multivessel PCI, including complete revascularization and incomplete revascularization, with regard to the procedure time and the risk of contrast-induced nephropathy. In our study, as shown in Supplementary Table S2 , STD (< 24 h vs. ≥ 24 h) was not an independent predictor of MACCE, all-cause death, CD, and non-CD in both the CKD and non-CKD groups.…”

What More Can Be Delivered to Future Patients with Coronary Syndromes?

“…Two papers on percutaneous coronary intervention (PCI) were published in Korea and Japan. Kim et al [ 4 ] revealed that differences in reperfusion strategies did not significantly affect prognosis in patients with multivessel non-ST-elevation myocardial infarction and chronic kidney disease, emphasizing the need for further investigation of the optimal perfusion strategy. Noma et al [ 5 ] reported that adjunctive catheter-derived thrombolysis with intracoronary monteplase delivery resulted in favorable outcomes in patients with ST-elevation myocardial infarction, especially in those with a high thrombus burden who were refractory to primary PCI procedures.…”