Single or multivessel percutaneous coronary intervention in ST‐elevation myocardial infarction patients

Varani, Elisabetta; Balducelli, Marco; Aquilina, Matteo; Vecchi, Giuseppe; Naseem, Mohamed; Frassineti, Valeria; Maresta, A

doi:10.1002/ccd.21722

Cited by 98 publications

(80 citation statements)

References 22 publications

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“…Therefore, our findings strengthen those of previous studies. 8,17,20) Third, the clinical outcomes were found to be similar between the "early" and "late" non-IRA PCI groups.…”

Section: Discussionmentioning

confidence: 81%

“…16,17,20,21) Some studies have suggested that complete revascularization during primary PCI has a positive impact on the clinical outcome. 17,20) In contrast, other studies have shown that one-stage primary PCI for IRA and non-IRA not only provide no additional therapeutic benefit, but also increased the incidence of adverse clinical outcomes. This could be mainly due to an inappropriate selection of timing and extent of revascularization in patients with MVD after acute reperfusion therapy.…”

Section: Figurementioning

confidence: 99%

“…8,[16][17][18][19] Another issue is the fact that the suitable timing and extent of revascularization for non-IRA after primary PCI remain universally inconsistent. 8) While some reports have claimed an improved short-term clinical outcome from complete revascularization during primary PCI, 17,20) other studies found that the potential harm actually outweighed the benefits for simultaneous PCI to non-IRA during primary PCI. 16,21) In the current study, the prognostic outcomes of patients with single-vessel disease (SVD) and those with MVD were compared.…”

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confidence: 99%

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

et al. 2010

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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)

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“…Therefore, our findings strengthen those of previous studies. 8,17,20) Third, the clinical outcomes were found to be similar between the "early" and "late" non-IRA PCI groups.…”

Section: Discussionmentioning

confidence: 81%

Section: Figurementioning

confidence: 99%

mentioning

confidence: 99%

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

et al. 2010

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“…This is due to the concern that noninfarct vessel PCI at the time of PCI for STEMI may increase the risk of adverse events [93,94], although other studies suggest it may be safe [95][96][97]. In the American College of Cardiology (ACC) survey, only 2% of cardiologists advocated noninfarct-related PCI of severely stenosed vessels at the time of the initial PCI [9].…”

Section: Specific Patient Subsets St Elevation Myocardial Infarctionmentioning

confidence: 99%

Staging of multivessel percutaneous coronary interventions: An expert consensus statement from the Society for Cardiovascular Angiography and Interventions

Blankenship

Moussa

Chambers

et al. 2011

Cathet Cardio Intervent

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Percutaneous coronary interventions (PCIs) to treat multivessel coronary artery disease (MVCAD) may involve single-vessel or multivessel interventions, performed in one or more stages. This consensus statement reviews factors that may influence choice of strategy and includes six recommendations to guide decisions regarding staging of PCI [1]. Every patient who undergoes PCI should receive optimal therapy for coronary disease, ideally before starting the procedure [2]. Multivessel PCI at the time of diagnostic catheterization should be considered only if informed consent included the risks and benefits of multivessel PCI and the risks and benefits of alternative treatments [3]. When considering multivessel PCI, the interventionist should develop a strategy regarding which stenoses to treat or evaluate, and their order, method, and timing. This strategy should maximize patient benefits, minimize patient risk, and consider the factors described in this article [4]. For planned multivessel PCI, additional vessel(s) should be treated only if the first vessel is treated successfully and if anticipated contrast and radiation doses and patient and operator conditions are favorable [5]. After the first stage of the planned multistage PCI, the need for subsequent PCI should be reviewed before it is performed [6]. Third party payers and quality auditors should recognize that multistage PCI for MVCAD is neither an indication of poor quality nor an attempt to increase reimbursement when performed according to recommendations in this article.V C 2011 Wiley Periodicals, Inc.

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“…Earlier results of trials comparing MPS and CO approaches were controversial [12][13][14][15][16][17][18][19], probably due to the heterogeneity of patient samples, variable endpoints, distinct inclusion criteria and different study protocols. European and American Cardiology Societies for 2010-2013 [1][2][3] recommended limiting PPCI to the vessel with a culprit stenosis with the exception of cardiogenic shock and persistent ischaemia after PCI.…”

Section: Introductionmentioning

confidence: 99%

Coronary air embolism during coronary angiography: reminder of a potentially lethal but avoidable complication

Mahajan¹,

Asotra²,

Negi³

et al. 2017

Interventional-Cardiology

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Background: Preventive multivessel percutaneous coronary interventions (PCI) (in primary and staged revascularization) with second generation drug eluting stents (DES) in patients with STelevation myocardial infarction (STEMI) is unresolved and controversial issue of contemporary interventional cardiology. Twelve-month results of our randomized trial (NCT01781715) presented. Methods and findings: One-year outcomes of 136 consecutive patients with STEMI and multivessel coronary artery disease (MVCAD) (SYNTAX Score 18.9±7.7 points) undergoing primary PCI with zotarolimus-eluting stents (Resolute Integrity™ Stent, Medtronic) were evaluated. The patients were randomized into two groups of preventive multivessel stenting: Multivessel primary stenting (MPS primary, n=67) (the infarct-related artery (IRA) and non-IRA stenting during one PCI) and multivessel stenting in staged revascularisation (MSS, n=69) (the IRA only stenting during the primary PCI and non-IRA stenting during the same hospital period (10.1±5.1 days between PCIs). Over the 12-month observation there were no differences in adverse cardiovascular events among MPS and MSS group. Fatality outcomes in both groups were not exceeded 3%. No MI and re-PCI survival was 62 (92.5%) patients in MPS group and 67 (97.1%) in MSS group p>0.05). In general study population (n=136) MACE, re-MI, death and stent thrombosis obtained in 5.1%, 5.1%, 2.9% and 4.4% of patients, respectively. Conclusions: The use of similar latest generation DES and preventive approach (MPS and MSS with 10.1±5.1 days between procedures) used in index hospitalization period made it possible to obtain satisfactory results of revascularization compared to most similar randomized trials.

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Single or multivessel percutaneous coronary intervention in ST‐elevation myocardial infarction patients

Abstract: STEMI patients with MVD have a worse prognosis than those with SVD. MV-PCI in patients without hemodynamic compromise yields good short-term results, even if performed very early, with a 30-day mortality in between that of SVD patients and that of MVD patients with IRA-only treatment.

Cited by 98 publications

References 22 publications

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

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

Staging of multivessel percutaneous coronary interventions: An expert consensus statement from the Society for Cardiovascular Angiography and Interventions

Coronary air embolism during coronary angiography: reminder of a potentially lethal but avoidable complication

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